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 generally does not stop appeal or lawsuit deadlines, so an appeal is usually kept on time as well. These dates are estimates for general information; the date and instructions in your notice and plan documents control. If a deadline has passed or is very close, your plan, your state insurance department, a consumer assistance program or a licensed attorney may be able to explain what options exist.
Sources
- U.S. Department of Labor (EBSA): Filing a Claim for Your Health or Disability Benefits, last verified 2026-10-20
- HealthCare.gov: Internal appeals, last verified 2026-10-20
- HealthCare.gov: External review, last verified 2026-10-20
- CMS: First Level of Appeal, Redetermination by a Medicare Contractor, last verified 2026-10-20
- CMS: Reconsideration by the Medicare Advantage (Part C) Health Plan, last verified 2026-10-20
- Medicare.gov: Appeals in Original Medicare, last verified 2026-10-20
- eCFR: 42 CFR 438.402, Medicaid managed care appeals, not re-verified 2026-10-18 (automated check not permitted or not completed)
- MACPAC: Denials and Appeals in Medicaid Managed Care (PDF), last verified 2026-10-20
- Heimeshoff v. Hartford Life & Accident Ins. Co., 571 U.S. 99 (2013), not re-verified 2026-10-18 (automated check not permitted or not completed)
- Connecticut Insurance Department Bulletin IC-37 (contractual limitations period), last verified 2026-10-20
- Arizona DIFI: File a Complaint Against an Insurance Entity, not re-verified 2026-10-18 (automated check not permitted or not completed)
- Squaremouth (travel insurance comparison site): What to do if your claim was denied, last verified 2026-10-20
Page last reviewed October 20, 2026. Rules change; confirm with your notice, plan documents or the agency pages above.