How Many Times Can I Appeal an Insurance Denial?

Getting denied once doesn't mean it's over. The insurance appeals process is designed with multiple levels — and each level gives you another shot at reversing the decision. Here is how many times you can appeal and what each level involves.

Level 1: Internal Appeal

The first appeal goes back to your insurance company. You are asking them to reconsider their own decision. Under the ACA, all non-grandfathered health plans must offer at least one level of internal appeal. Some insurers offer two internal levels — for example, a reconsideration review followed by a committee review.

You typically have 180 days from the date of the denial notice to file an internal appeal (some plans allow more). If the first internal appeal is denied and your plan offers a second level, you may appeal again at that stage.

Level 2: External Independent Review: Complete Guide" class="auto-link">External Review

Once your internal appeal options are exhausted, you can escalate to external review — an independent third party called an IROs) Explained" class="auto-link">Independent Review Organization (IRO) that has no financial relationship with your insurer. Their decision is binding on the insurance company in nearly all states.

You generally have 4 months (about 120 days) from the date of the internal appeal denial to request external review.

External review is available for most clinical denials (medical necessity, experimental treatment, level of care) but typically not for administrative denials like missed filing deadlines.

Level 3: State Insurance Commissioner Complaint

Filing a complaint with your state's insurance commissioner is not technically an appeal, but it can prompt regulatory intervention. In some states, the commissioner's office will investigate the denial and pressure the insurer to reprocess the claim. This can run concurrently with other appeals.

Level 4: Federal or State Court

If all administrative remedies fail:

• ACA/state-regulated plans: You may sue in state court for breach of contract or bad faith.
• ERISA employer plans: Federal court is usually your only option. ERISA litigation is complex — an attorney is strongly recommended.
• Medicare: You can escalate through multiple administrative levels (redetermination → reconsideration → ALJ hearing → Medicare Appeals Council → federal court).

Special Rules for Medicare

Medicare has its own multi-level appeals process:

1. Redetermination (by the Medicare contractor)
2. Reconsideration (by a Qualified Independent Contractor)
3. ALJ hearing (before an Administrative Law Judge)
4. Medicare Appeals Council review
5. Federal district court (if the amount in controversy meets the threshold)

Each level has its own deadline, so staying on top of timelines is critical.

How Many Is "Too Many"?

There is no rule against appealing multiple times — as long as you haven't exhausted all available levels. Each level is a fresh review. Statistics show that external review overturns insurer decisions roughly 40–50% of the time in many states, so persistence pays off.

Even after a final denial, you may be able to reopen a claim if new medical evidence emerges, if you discover a procedural error in how the insurer handled your appeal, or if your treating physician obtains new clinical data.

Tips for Appealing Multiple Times

• Improve your submission with each round. A second internal appeal or external review should include more evidence — not just a resubmission of what failed the first time.
• Request the insurer's complete claim file. You are entitled to all documents the insurer relied on. Reviewing them often reveals errors or missing evidence.
• Get a peer-to-peer review. Your doctor can speak directly with the insurer's medical reviewer before or during an appeal — this alone sometimes reverses decisions.
• Don't miss deadlines. Each level has its own deadline. Missing it typically waives your right to that level.

Fight Back With ClaimBack

ClaimBack tracks your appeal stages, generates letters for each level, and helps you build stronger submissions at every round — so you never run out of options too soon.

Start your appeal at ClaimBack

Related Reading

• Internal vs. External Insurance Appeal: What's the Difference?
• How to Write an Insurance Appeal Letter
• Common Reasons Insurance Claims Are Denied