Insurance Appeal Deadlines: How Long Do You Have?

Insurance appeal deadlines are not suggestions. Miss them and you may permanently forfeit your right to challenge a denial. The rules are set by federal law, state law, and your specific plan documents — and they vary based on plan type, the nature of the denial, and whether the appeal is urgent. Here is a complete guide to every deadline that matters.

The Federal Baseline: ACA Appeal Timelines

The Affordable Care Act established minimum appeal rights for most health insurance plans. These apply to fully insured employer plans, individual and family plans (on or off the Marketplace), and small group plans. (ERISA self-funded employer plans have different rules — see below.)

Your Deadline to File an Internal Appeal

180 days from the date you receive the denial notice or EOB.

This is the most critical deadline. If you do not file your internal appeal within 180 days, you lose the right to appeal that specific claim. Most insurers will not make exceptions for missed deadlines.

The clock starts when you receive the denial — not when the service was provided. Your EOB and denial letter should both be dated; if they differ, use the earlier date.

How Long the Insurer Has to Decide

Once you file an internal appeal, the insurer has a legally mandated response window:

These are maximum windows — the insurer can decide faster. If the insurer does not decide within the applicable window, the denial is considered exhausted and you may proceed directly to External Independent Review: Complete Guide" class="auto-link">external review.

External Review Deadline

After your internal appeal is exhausted (either denied or the insurer fails to decide in time), you have 4 months (approximately 120 days) to request external independent review.

Do not wait 4 months. File for external review as soon as your internal appeal is denied. External review by an IROs) Explained" class="auto-link">independent review organization (IRO) is binding on the insurer and reverses denials in a meaningful percentage of cases.

For urgent/expedited external review: the IRO must decide within 72 hours.

Medicare Appeal Deadlines

Medicare has its own five-level appeal structure with specific deadlines at each level:

• Redetermination (Level 1): File within 120 days of the Medicare Summary Notice (MSN) or Explanation of Medicare Benefits (EOMB). CMS must respond in 60 days.
• Reconsideration/QIC (Level 2): File within 180 days of the Redetermination decision. QIC decides in 60 days.
• ALJ Hearing (Level 3): File within 60 days of the QIC decision. Minimum amount in controversy: $200 (2026 adjusted figure).
• Medicare Appeals Council (Level 4): File within 60 days of the ALJ decision.
• Federal District Court (Level 5): File within 60 days of the Council decision. Minimum amount in controversy: $1,870 (2026 adjusted figure).

For Medicare Advantage (Part C): 60 days to file a plan appeal; 14-day decision for standard pre-service appeals; 72 hours for expedited.

Medicaid Appeal Deadlines

Medicaid fair hearing deadlines are set by federal law and state implementation:

• Federal baseline: 90 days from the notice of adverse action
• Some states are shorter: Many states require the hearing request within 30-60 days
• Aid continuing: If you request a fair hearing before your benefits are reduced or terminated, your current benefits must continue during the appeal process

Always check your state's Medicaid agency website for the exact hearing request deadline in your state.

ERISA Self-Funded Plans

For self-funded employer health plans governed by ERISA (typically large employers), the ACA's consumer protections apply to the claims and appeals procedure regulations, but state insurance mandates do not. Key ERISA timelines:

• Internal appeal filing deadline: Minimum 180 days under federal ERISA regulations, but your plan documents may specify a longer or (if grandfathered) shorter window
• Plan decision on appeal: Same ACA windows apply (30/60/72 hours)
• ERISA lawsuit: Must exhaust administrative remedies first; then a federal lawsuit may be filed (there is no state-law external review requirement for most self-funded plans, though the federal external review process applies)

State Law Variations

States can and do provide appeal rights that are more generous than the federal minimum. Examples:

• California: 180-day appeal deadline (matches ACA); Independent Medical Review (IMR) through the Department of Managed Health Care (DMHC) must be decided in 30 days (3 days for urgent)
• New York: External appeal must be filed within 45 days of final internal denial
• Texas: External review must be filed within 6 months of final internal denial

When state law provides more protection than federal law, you get the benefit of both. Check your state insurance department's website for your state's specific rules.

Practical Deadline Tracking

Use this checklist when you receive a denial:

1. Date received: Write the date you received the denial on the envelope or note it in your calendar immediately
2. Internal appeal deadline: Add 180 days from receipt date (or your plan's specified deadline if shorter)
3. Set a calendar alert: 30 days before the deadline as a warning; 7 days before as a final warning
4. Track insurer response: Note when you submitted the appeal; count the decision window from that date
5. External review deadline: Set a separate calendar alert for 4 months after your internal appeal submission date (not after you receive the internal appeal denial)

If you are approaching a deadline and your appeal is not complete, submit what you have and supplement later. A timely-but-incomplete appeal preserves your rights; a late appeal does not.

Missing a deadline is one of the most preventable reasons people lose valid claims. Track the dates from day one.

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Related Reading:

• How to Write an Insurance Appeal Letter
• What Is Medical Necessity?
• Internal vs External Insurance Appeal