Internal vs External Appeal: What's the Difference?

Internal Appeal

An internal appeal is reviewed by your insurance company — but by someone different from the person who made the original denial decision.

Key Facts

• Must be filed first (before external review)
• Deadline: typically 30-180 days from denial notice
• Decision within 30 days (pre-service) or 60 days (post-service)
• You can submit new evidence, doctor letters, and medical records
• Your insurer must use a different reviewer than the original decision-maker

External Appeal

An external review is conducted by an independent third party — NOT your insurance company.

Key Facts

• Available after internal appeal exhaustion (or sometimes simultaneously)
• Reviewed by independent medical experts
• Decision is binding on the insurance company
• You can request external review for medical necessity denials, experimental treatment denials, and rescissions
• Typically decided within 45 days (72 hours for expedited)

When to Use Each

Start with internal appeal — it's required in most cases. If denied, escalate to external review. For urgent cases, request expedited review at both levels simultaneously.