My claim was denied
How long do I have to appeal?
Photo: Pavel Danilyuk / Pexels
For most private health plans, about 180 days from the denial letter. Medicare deadlines are shorter. Your exact deadline is printed on the letter. Use that time with care: what you put in the appeal, and what you leave out, matters as much as the date.
What to do
- Find the deadline on the letter.
- Write it on the envelope.
- Read the reason for the denial before you call.
What to say
What documentation would you need to approve this?
Say it exactly like that. It turns a no into a to-do list.
What to watch out for
This is a sensitive stepSmall details here can change the outcome, and some mistakes are hard to undo. We highly recommend a free 15-minute call with us before you decide.
Sending too much, or too little. A stack of everything can bury the one page the reviewer needs, and an appeal that's too thin can make things worse, not better. Take the time to choose carefully what goes in and what stays out.
Also: putting the letter in a drawer. A week to breathe can quietly become four months.
Better done together
We’re here to help
Finding the date is the easy part. Using the time well is where people get stuck: working out what the plan actually needs, which records to gather, and which level of appeal you are at.
We can sit down with your letter, find the deadline together and map out the steps, so the appeal doesn't drag on. We'll do it with you the first time; after that, you'll know how to do it on your own.
Every situation is different, and these are sensitive moments, so we look at yours with care. We often see what others miss, and we never take commissions from insurance companies: the only thing we are working for is what is right for you.
Free · 15 minutes · No pressure
The rule behind it
For job-based and individual plans, federal rules give you at least 180 days from the denial notice to file an internal appeal (29 CFR 2560.503-1(h)(3)(i), which the Affordable Care Act rule at 45 CFR 147.136 also applies). Medicare's deadlines are shorter. In Original Medicare you have 120 days from receiving your Medicare Summary Notice. With a Medicare Advantage plan or a Part D drug plan, you have 65 days from the date on the plan's denial notice. Your letter shows your exact date.
Sources
- HealthCare.gov — Internal appeals
- 29 CFR 2560.503-1 — claims procedure (180 days)
- 45 CFR 147.136 — ACA internal claims and appeals
- CMS — First level of appeal: redetermination (120 days)
- Medicare.gov — Appeals in Medicare health plans (65 days)
- Medicare.gov — Appeals in Medicare drug plans (65 days)
- Medicare.gov — Your Medicare Summary Notice
Amanda Alcodia
Education, not medical, legal or insurance advice.
Useful next steps
Start with the free Kit. If your situation needs a person, the intro call is free too.