Insurance Appeal Deadlines: Don't Miss Your Window
Missing your appeal deadline means losing your right to challenge a denial. Deadlines vary significantly by plan type and state. This guide covers every scenario so you never miss your window.
Appeal Deadlines by Plan Type
Employer-Sponsored Plans (ERISA)
- Internal appeal: 180 days from denial notice
- Urgent care appeal: Must be decided within 72 hours
- Pre-service appeal: Must be decided within 30 days
- Post-service appeal: Must be decided within 60 days
- External review: 4 months after exhausting internal appeals
Individual/ACA Marketplace Plans
- Internal appeal: 180 days from denial notice
- Expedited appeal: Available for urgent/emergency situations — 72 hours
- External review: Available after one internal appeal denial
- External review deadline: 4 months from final internal denial
Medicare Advantage
- Standard appeal (Part C): 60 days from denial
- Expedited appeal: Available if delay could harm health — 72 hours
- Part D (prescription): 60 days from denial
- Medicare fee-for-service: 120 days from date on MSN
Medicaid
- Varies by state — typically 30-90 days
- Fair hearing request: Usually 90 days
- Managed care appeal: Usually 60 days
- Expedited: Available for urgent cases
What Happens If You Miss the Deadline?
If you miss the internal appeal deadline:
- You may lose the right to internal appeal
- You may still be able to request an external review in some states
- Some states have "good cause" exceptions for late filings
- You may need to refile the claim entirely
Tips to Protect Your Deadline
- Mark the deadline immediately when you receive a denial
- Send appeals via certified mail with return receipt
- Keep copies of everything — every letter, fax confirmation, email
- Set calendar reminders 30 and 14 days before the deadline
- If in doubt, file early — you can supplement later