When a standard appeal timeline would put your health at serious risk, you have the right to an expedited appeal. Insurers must respond within 72 hours (or faster in some cases). This guide explains when and how to use this critical process.
When to Request Expedited Appeal
Expedited appeals are appropriate when standard timelines would:
- Seriously jeopardize your life or health
- Jeopardize your ability to regain maximum function
- Subject you to severe pain that can't be adequately managed waiting for standard review
How to Request
By Phone
- Call the number on your denial letter or insurance card
- State that you need an expedited or urgent appeal
- Your doctor can call on your behalf (often more effective)
In Writing
- Write "EXPEDITED APPEAL — URGENT" on your appeal letter
- Include your doctor's statement explaining the urgency
- Fax the appeal for faster processing (in addition to mailing)
Timelines| Plan Type | Decision Deadline |
|---|
| ACA plans — pre-service urgent | 72 hours |
| ACA plans — concurrent care | 24 hours |
| ERISA plans — urgent | 72 hours |
| Medicare — expedited | 72 hours |
| Medicare Advantage — expedited | 72 hours |
| Medicaid — expedited | 3 business days (varies by state) |
| External review — expedited | 72 hours |
Tips
- Have your doctor request the expedited review — carries more weight
- Document the urgency — clinical evidence of harm from delay
- Follow up within 24 hours if you haven't heard back
- File simultaneously: Write to the insurer AND your state commissioner
- Concurrent care: If you're currently receiving treatment that's being terminated, you may be entitled to continuation during the appeal