How Long Do I Have to Appeal an Insurance Denial?

When you get an insurance denial, one of the first thoughts that hits you is: how much time do I have?

This is one of the most important questions you can ask — because missing your appeal deadline can permanently forfeit your right to challenge the denial. Insurance companies are very good at enforcing these deadlines. You need to be, too.

The good news: in most cases, you have more time than you think. The bad news: the clock started when you received that denial notice.

Here are the exact deadlines you need to know.

Appeal Deadlines by Plan Type

erisa">Employer-Sponsored Plans (ERISA)

Most Americans get health insurance through their employer, and these plans are governed by a federal law called ERISA. Under ERISA-governed plans:

• Internal appeal deadline: 180 days (6 months) from the date you receive the denial notice
• External Independent Review: Complete Guide" class="auto-link">External review deadline: 4 months (122 days) after your internal appeal is denied
• Expedited appeal (urgent care): insurer must respond within 72 hours

The 180-day window for internal appeals is relatively generous — but don't use that as an excuse to procrastinate. The stronger your appeal, the sooner you file it, and the more time you have to gather documentation.

ACA Marketplace / Individual Plans

If you bought your insurance through Healthcare.gov or a state exchange, your plan is ACA-regulated. The minimum requirements under federal rules are:

• Internal appeal deadline: at least 30 days from the denial notice (many plans offer 60 or 180 days — check your plan documents)
• External review deadline: 60 days after the internal appeal denial
• Expedited review (urgent medical need): insurer must respond within 72 hours

Because the minimum is only 30 days for some plans, check your denial letter immediately for your specific deadline.

Medicare

Medicare has its own multi-level appeal system with specific names for each level:

• Level 1 – Redetermination: 120 days from the date you receive the initial claims decision

• Level 2 – Reconsideration (by a Qualified Independent Contractor): 180 days after Level 1 denial

• Higher levels: Additional timelines apply at each subsequent level

• Expedited appeal for Medicare Advantage or Part D: 24 to 72 hours depending on urgency

Medicare beneficiaries also have the right to request a fast appeal if they're being discharged from a hospital before they feel ready — this can be filed even on the day of discharge.

Medicaid

Medicaid is administered at the state level, so deadlines vary. The general federal minimum is:

• Fair hearing (internal appeal equivalent): typically 90 days from the notice of action, but many states set shorter windows of 30–60 days

Check with your state Medicaid office immediately. Some states have windows as short as 30 days and are strict about enforcement.

CHIP (Children's Health Insurance Program)

Deadlines mirror your state's Medicaid rules. Contact your state CHIP office for specifics.

Short-Term or Non-ACA Plans

These plans have fewer consumer protections. Appeal deadlines and rights may be specified only in your plan documents — read them carefully, as some offer very short windows.

What "Date of Denial" Actually Means

The clock usually starts when you receive the denial notice, not when it's issued. If you receive it by mail, federal rules typically assume you received it 5 days after the mailing date.

This matters if there's any ambiguity about when you received the notice. Document when you actually received communications from your insurer.

What Happens If You Miss the Deadline?

In most cases, missing the appeal deadline means you lose your right to challenge that specific denial. This is not a situation most insurers will make exceptions for.

There are limited circumstances where exceptions are made — for example, if you can demonstrate you never received proper notice of the denial or the deadline, or in some cases of mental or physical incapacity. But these are narrow exceptions, not reliable escape hatches.

If you're close to your deadline and not ready to file a complete appeal, file something anyway. A brief initial appeal letter preserves your rights while you continue gathering documentation. You can supplement the record after filing.

The Special Case: Expedited / Urgent Appeals

If your health situation is urgent — meaning the standard appeal timeline would seriously jeopardize your health — you have the right to request an expedited review. This applies when:

• You're currently receiving treatment and it's being cut off
• You need urgent care that requires advance approval
• Waiting the full timeline poses a genuine health risk

For expedited reviews, the insurer must respond within 72 hours (or 24 hours in some Medicare situations). Your doctor must support the urgency in writing.

Start Now — Even If You're Not Ready

Here's the most important advice: don't wait until you have a perfect appeal to submit something. If your deadline is approaching, file a brief letter stating you are filing an appeal and will submit supplemental documentation. This preserves your rights.

Then gather your documentation — medical records, your doctor's letter of medical necessity, peer-reviewed literature, and a strong appeal letter.

Fight Back With ClaimBack

ClaimBack helps you build a complete, compelling appeal before your deadline hits. Don't let time run out on a denial that can be overturned.

Start your appeal at https://claimback.app/appeal

The clock is running. Start now.

Related Reading

• How to Appeal an Insurance Denial: Step-by-Step
• Internal vs. External Insurance Appeal: Which Should You File?
• Common Reasons Insurance Claims Are Denied