Insurance appeal deadlines by denial type
Estimate when your first appeal is due. The date on your notice controls; this is a starting point.
Deadline guide by denial type (health)
| Step | Employer plan (ERISA) | Marketplace / individual | Original Medicare | Medicare Advantage | Medicaid managed care |
|---|---|---|---|---|---|
| File first appeal | At least 180 days after receiving the denial | 180 days from receiving the denial | 120 days from receipt (notice presumed received 5 days after its date) | 65 days from date on notice | 60 calendar days from date on notice |
| Plan decides (appeal) | 72 hours urgent; 30 days before-care; 60 days after-care (one level) | 30 days before-care; 60 days after-care | Generally within 60 days | 30 days before-care; 60 days payment; 72 hours fast | 30 days; 72 hours urgent |
| Next level | External review for non-grandfathered plans (federal standard: 4 months to file) | External review: 4 months to file; decision in 45 days (72 hours expedited) | Level 2 (QIC): 180 days after level 1 decision | Automatic forward to independent review entity if plan upholds | State fair hearing: 90 to 120 days from plan's resolution notice |
Other insurance
| Type | Deadline to know |
|---|---|
| Employer disability (ERISA) | At least 180 days to appeal; plan may set its own time limit for suing, which courts can enforce. Read this. |
| Homeowners / renters | Set by your policy and state law (suit-limitation, proof-of-loss and appraisal clauses). Find them today. Guide. |
| Auto | Policy-specific; see guide. |
| Travel | Policy-specific; one comparison site says 30, 60 or 90 days is common. Guide. |
Important: a state insurance department complaint does not stop appeal or lawsuit deadlines. Keep appealing on time. If your deadline has passed or is very close, call your plan, your state department or consumer assistance program, and consider a lawyer.
Sources
- U.S. Department of Labor (EBSA): Filing a Claim for Your Health or Disability Benefits, last verified 2026-10-17
- HealthCare.gov: Internal appeals, last verified 2026-10-17
- HealthCare.gov: External review, last verified 2026-10-17
- CMS: First Level of Appeal, Redetermination by a Medicare Contractor, last verified 2026-10-17
- CMS: Reconsideration by the Medicare Advantage (Part C) Health Plan, last verified 2026-10-17
- Medicare.gov: Appeals in Original Medicare, last verified 2026-10-17
- eCFR: 42 CFR 438.402, Medicaid managed care appeals, last verified 2026-10-17
- MACPAC: Denials and Appeals in Medicaid Managed Care (PDF), last verified 2026-10-17
- Heimeshoff v. Hartford Life & Accident Ins. Co., 571 U.S. 99 (2013), last verified 2026-10-17
- Connecticut Insurance Department Bulletin IC-37 (contractual limitations period), last verified 2026-10-17
- Arizona DIFI: File a Complaint Against an Insurance Entity, last verified 2026-10-17
- Squaremouth (travel insurance comparison site): What to do if your claim was denied, last verified 2026-10-17
Page last reviewed October 17, 2026. Rules change; confirm with your notice, plan documents or the agency pages above.