Expedited Appeals: When Your Health Can't Wait

When your health condition is urgent — ongoing treatment, severe pain, or a rapidly progressing illness — you can file an expedited appeal that must be decided within 72 hours. Here's how to ensure your urgent appeal is processed quickly.

What Qualifies for Expedited Appeal?

An expedited (urgent) appeal is available when:

  • The standard appeal timeframe could seriously jeopardize your life or health
  • You're currently undergoing treatment that may be terminated
  • Your doctor certifies that the delay would harm you
  • The treatment is time-sensitive (e.g., cancer treatment, transplant)

How to File an Expedited Appeal

Step 1: Get Your Doctor's Certification

Your physician must certify that the standard timeline could seriously jeopardize your health. This can be done by phone or fax.

Step 2: Contact the Insurer

Call the number on your denial letter and explicitly request an expedited urgency appeal. Note the date, time, and representative's name.

Step 3: Submit Supporting Documentation

Fax or submit electronically:
  • Doctor's urgency certification
  • Letter of medical necessity
  • Relevant medical records
  • The denial letter

Step 4: Follow Up

The insurer must decide within 72 hours. If they don't respond in time, or if they deny the expedited appeal, you can immediately request an expedited external review.

Your Rights During Expedited Review

  • The insurer cannot require you to file a standard appeal first
  • You can file by phone — written filing is not required
  • The insurer must notify you of the decision as quickly as possible
  • If approved, coverage must begin immediately

Need Help Writing Your Appeal?

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Frequently Asked Questions

How fast must an expedited appeal be decided?

Insurance companies must decide expedited appeals within 72 hours. This applies to pre-service urgent care claims. If the insurer fails to respond within 72 hours, you can immediately request an expedited external review.

Can I file an expedited appeal by phone?

Yes, for urgent situations you can initiate an expedited appeal by phone. The insurer cannot require written filing for expedited appeals, though it's recommended to follow up your phone call with written documentation.

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