How long do I have to appeal a health insurance denial?
For most employer and ACA marketplace plans, at least 180 days from the day you receive the denial to file the internal appeal, and generally about four months after the final internal denial to request external review. Medicare Advantage and Medicaid use different, shorter clocks, and the exact date printed on your denial letter is the one that binds you.
What to do, in order
- Step 1
Find the date the clock starts
It is the date you received the denial notice or Explanation of Benefits, not the date of service. Keep the envelope or the portal timestamp.
- Step 2
Identify the plan type
Employer plan (insured or self-funded), individual or marketplace plan, Medicare Advantage, Original Medicare, Medicaid, or TRICARE. Each has its own window.
- Step 3
Use the calculator, then verify on the letter
Apellica's deadline calculator applies the federal floor for each plan type and cites the rule. The letter can only give you more time than the floor, never less, but it can name a specific date.
- Step 4
File early and keep proof
Fax confirmation, certified-mail receipt, or the portal's submission record. Filing on day 179 is legal; filing on day 30 leaves room to fix a rejected submission.
The deadline that applies
Employer and ACA plans: at least 180 days to file an internal appeal, and plans must decide within 30 days (pre-service) or 60 days (post-service), 72 hours if urgent (29 CFR 2560.503-1; 45 CFR 147.136). External review: about four months after the final internal denial under the federal process. Original Medicare: 120 days for the first level (redetermination). Medicare Advantage: a shorter reconsideration window under 42 CFR 422.582. Medicaid: set by your state, often 90 days.
Calculate your date →Documents to gather
- The denial letter with the date you received it
- The plan documents that state the appeal procedure
- Proof of filing for every submission
Go deeper
Related questions
Is the deadline counted from the date of service?
No. It runs from the date you receive the adverse benefit determination, the denial notice.
What if the letter gives a shorter deadline than 180 days?
For an ACA-compliant or ERISA plan, 180 days is a federal floor and the plan cannot shorten it. A shorter date on a letter is worth raising in the appeal itself; grandfathered, church and some government plans can differ.
How fast must the plan answer an urgent appeal?
Within 72 hours for urgent-care claims, where a delay could seriously jeopardise life, health or the ability to regain maximum function (29 CFR 2560.503-1(i)(2)(i)).
Sources
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