How Long Do You Have to Appeal an Insurance Denial?

Insurance appeal deadlines vary by plan type, state, and whether the denial involves pre-service or post-service care. Missing a deadline can forfeit your appeal rights entirely.

Standard Appeal Deadlines

ACA-Compliant Plans (Individual & Small Group)

  • Internal appeal: 180 days from denial notice
  • External review: 4 months from final internal denial (varies by state)
  • Urgent/concurrent care: No waiting period — can request expedited review immediately

ERISA Plans (Employer-Sponsored)

  • Pre-service claims: 180 days to file appeal; plan has 30 days to decide
  • Post-service claims: 180 days to file appeal; plan has 60 days to decide
  • Urgent claims: Appeal decided within 72 hours
  • Disability claims: 180 days to file; plan has 45 days to decide (extendable)

Medicare

  • Redetermination: 120 days from denial
  • Reconsideration: 180 days from Level 1 decision
  • ALJ hearing: 60 days from Level 2 decision

Medicaid

  • Varies by state: Typically 30-90 days
  • Aid-continuing: Usually must file within 10 days to keep services running

Tips for Meeting Deadlines

  1. Mark the deadline immediately when you receive a denial
  2. File early — don't wait until the last day
  3. Send by certified mail to prove timely filing
  4. If you miss a deadline: Ask for a good-cause exception (some plans allow it)

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Frequently Asked Questions

What happens if I miss my insurance appeal deadline?

If you miss the internal appeal deadline, you may lose your right to appeal internally and to external review. However, some plans and states allow good-cause exceptions. You may also still be able to file a complaint with your state insurance commissioner.

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