FAQ: How Long Does an Insurance Appeal Take? (All Countries)
How long does an insurance appeal take? Get exact timelines for US, UK, Australia, Singapore, and Malaysia — including internal appeal deadlines, external review timelines, and what to do if your insurer is late.
FAQ: How Long Does an Insurance Appeal Take?
One of the most common questions from people fighting an insurance denial is: how long will this take? The answer depends on which country you're in, which type of insurance plan you have, and how far up the escalation ladder your dispute needs to go.
This guide provides exact, legally mandated timelines for appeals in the US, UK, Australia, Singapore, and Malaysia — plus what to do when an insurer exceeds these deadlines.
United States — Health Insurance Appeal Timelines
Internal Appeal (ACA and ERISA Plans)
Standard internal appeal:
- The insurer must make a decision within 60 days of receiving your appeal
Expedited/urgent internal appeal (for urgent medical situations where waiting would seriously harm your health):
- Decision required within 72 hours
If the insurer fails to respond within these periods:
- The denial is treated as a final adverse determination
- You can immediately request external review without waiting further
External Review (US)
After the internal appeal is exhausted (or deemed exhausted due to insurer non-response):
Standard external review:
- Decision required within 45 calendar days
Expedited external review (urgent medical situations):
- Decision required within 72 hours
Medicare Advantage Appeal Timelines
| Level | Standard | Expedited |
|---|---|---|
| Level 1 (Plan) | 30 days (pre-service) / 60 days (post-service) | 72 hours |
| Level 2 (IRE) | 30 days | 72 hours |
| Level 3 (ALJ Hearing) | 90 days to schedule | N/A |
| Level 4 (MAC) | 90 days | N/A |
Medicare Part D (Drug) Timelines
| Level | Standard | Expedited |
|---|---|---|
| Coverage determination | 72 hours | 24 hours |
| Redetermination (plan) | 7 days | 72 hours |
| Reconsideration (IRE) | 30 days | 72 hours |
Medicaid (US) Timelines
For Medicaid managed care:
- MCO internal appeal: Decision within 30 days (standard) or 72 hours (expedited)
- State fair hearing: Varies by state; typically must be requested within 90–120 days of denial
TRICARE Timelines
- Contractor reconsideration: 30 days
- DHA formal appeal: 60 days
United Kingdom — Insurance Complaint Timelines
For complaints to FCA-regulated insurers (health, life, critical illness, property, motor, travel):
| Step | Timeline |
|---|---|
| Initial acknowledgement | 5 business days |
| Final Response (resolution) | 8 weeks |
| Financial Ombudsman (after Final Response or 8 weeks) | 3–6 months average (can be longer for complex cases) |
FOS note: The FOS handles hundreds of thousands of cases annually. Straightforward cases can be resolved in 3 months; complex cases may take 12 months or more. You can contact the FOS at any time after 8 weeks have passed without a Final Response.
Australia — Private Health Insurance Timelines
Private Health Insurance Ombudsman (PHIO)
- PHIO typically resolves complaints within 4–8 weeks for straightforward cases
- Complex cases may take several months
Australian Financial Complaints Authority (AFCA)
Under AFCA rules:
- Initial response from insurer: 5 business days
- Resolution of complaint: 45 days for general insurance, 45 days for life insurance
- If unresolved, AFCA investigation: 6–9 months for complex cases (AFCA has binding authority)
Health Fund Internal Review
Health fund reviews: Typically 5–30 days depending on the fund and complexity
Singapore — Insurance Complaint Timelines
| Step | Expected Timeline |
|---|---|
| Insurer acknowledgement | 2 business days |
| Simple complaints resolution | 14 days |
| Complex complaints resolution | Up to 8 weeks |
| FIDREC mediation | Weeks to months |
| FIDREC adjudication | Months |
FIDREC note: FIDREC's timeline from filing to adjudicated decision typically runs 3–9 months depending on complexity and whether both parties can reach settlement at the mediation stage.
Malaysia — Insurance Complaint Timelines
| Step | Expected Timeline |
|---|---|
| Insurer complaint acknowledgement | Few business days |
| Insurer complaint resolution | 60 days |
| OFS mediation | Weeks |
| OFS adjudication | Months |
OFS note: The OFS aims to resolve complaints within 6 months of filing. Mediated settlements often occur faster.
Tips for Managing the Timeline
File everything promptly: Don't wait until the last possible moment to file your appeal. Filing early gives you more time for follow-up if there are delays.
Send by certified mail: Creates proof of the filing date.
Use expedited/urgent appeals when genuinely urgent: If your medical condition requires faster resolution, invoke the expedited process explicitly and explain why.
Follow up before the deadline: If the insurer hasn't responded with 50–55 days of a 60-day internal appeal (US), call and ask for a status update. Document this call.
File simultaneously where allowed: In many jurisdictions, you can file a regulatory complaint (State DOI, FCA, PHIO) simultaneously with your internal appeal. This creates parallel pressure.
Don't wait for the internal appeal to file externally: In the US, if the internal appeal period passes without a response, you can request external review immediately. In the UK, you can go to the FOS after 8 weeks.
What Happens if the Insurer Misses the Deadline?
US: Missing the internal appeal deadline is treated as a final adverse determination — you can request external review immediately. Document the missed deadline carefully.
UK: If the insurer doesn't issue a Final Response within 8 weeks, you can go to the FOS immediately, even without a Final Response.
Australia: PHIO and AFCA can take jurisdiction if the insurer doesn't respond within required timeframes.
Singapore/Malaysia: After the required resolution period passes without resolution, FIDREC/OFS can accept your complaint regardless.
Realistic End-to-End Timelines
Putting it all together, here's a realistic end-to-end timeline from initial denial to final resolution:
US health insurance (going all the way to external review):
- Internal appeal: 60 days (standard) or 72 hours (urgent)
- External review: 45 days (standard) or 72 hours (urgent)
- Total: approximately 3–4 months for standard track
UK FOS complaint:
- Insurer's Final Response: up to 8 weeks
- FOS investigation: 3–6 months (simple) to 12+ months (complex)
- Total: 4–14+ months
Australia AFCA:
- Insurer's internal process: 45 days
- AFCA process: 2–9 months
- Total: 3–12+ months
Singapore FIDREC:
- Insurer's process: 8 weeks
- FIDREC process: 3–9 months
- Total: 4–12 months
Conclusion
Insurance appeals take time — typically months for internal appeals and external review combined. Understanding the exact deadlines in your jurisdiction lets you know when to escalate if the insurer is late. The key is to file promptly, follow up diligently, and use expedited processes when your situation is urgent. Use ClaimBack at claimback.app to generate a professional appeal letter and keep your dispute moving forward efficiently.
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