How Long Do You Have to Appeal? State-by-State Insurance Deadlines
Insurance appeals are governed by hard deadlines. Miss one, and you may permanently forfeit your right to fight the denial. This is not a bureaucratic technicality — it is the most common reason people lose appeals that they should have won. This guide explains every deadline you need to know, from the federal baseline to state-specific rules.
The Federal Baseline Deadlines (Applies to Most Plans)
Under the ACA and federal ERISA regulations, the following minimum deadlines apply to most health plans:
| Appeal Type | Your Filing Deadline | Insurer Response Deadline |
|---|---|---|
| Internal Appeal (Standard) | 180 days from denial notice | 30 days (pre-service) / 60 days (post-service) |
| Internal Appeal (Urgent/Expedited) | Same as standard | 72 hours |
| External Review (Standard) | 60 days from final internal denial | 45 days from IRO receipt |
| External Review (Expedited) | Same as standard | 72 hours from IRO receipt |
Note: These are minimum federal deadlines. Your actual deadline may differ — always check the specific deadline stated in your denial letter.
State-Specific Deadline Highlights
States can provide stronger protections than the federal baseline. Below are highlights for the most common state variations. Always check your specific state's DOI for the most current rules.
- California: You can request an Independent Medical Review (IMR) concurrent with your internal appeal in urgent situations — you do not have to wait for the internal process to complete. IMR request deadline: generally 180 days from the denial.
- New York: External appeal deadline is 45 days from the final internal denial (or 60 days from receiving a denial of coverage, whichever is later) — slightly different from the federal standard.
- Texas: External review deadlines follow federal minimums. The Texas Department of Insurance recommends filing complaints within 2 years of the denial.
- Florida: Internal appeal deadline of 365 days for some plans — longer than the federal minimum. Check your denial letter for the specific deadline.
- Illinois: Follows federal timelines. The state DOI complaint window is generally 2 years from the date of service.
For a comprehensive state-by-state resource, see our state appeal guide.
Deadlines for Specific Plan Types
Medicare Advantage Plans
Medicare Advantage has its own appeal timeline: 60 days from the denial to file a standard appeal. Expedited appeals must be decided within 72 hours. The process involves multiple levels including Qualified Independent Contractors (QICs), ALJ hearings, and federal court.
Medicaid
Medicaid appeal deadlines are set by state law and vary widely. Most states allow 30–90 days from the notice of action. Check your state Medicaid agency's website or contact your caseworker.
Self-Funded Employer Plans (ERISA)
ERISA plans follow federal DOL deadlines: 180 days for internal appeals. After exhausting internal appeals, you can pursue legal action in federal court — there is no mandatory external review for ERISA plans, though many plans voluntarily offer it.
How to Find Your Specific Deadline
Every denial letter must state your specific appeal deadline. If it does not, contact your insurer immediately and ask for clarification in writing. The deadline on your denial letter controls — do not rely on general rules alone.
Once you know your deadline, act immediately. Start building your appeal package, request your complete claim file from your insurer, and schedule a meeting with your doctor to get a Letter of Medical Necessity. Use our free appeal letter builder to draft your letter.
For a complete understanding of the insurance appeal process and what to do at each stage, review our comprehensive overview.
Frequently Asked Questions
- What happens if I miss the internal appeal deadline?
- If you miss the internal appeal deadline, you typically forfeit your right to an internal appeal and to an external review. In some cases, you may be able to request an extension by demonstrating "good cause" for the delay — illness, unavailability of records, etc. Always contact your insurer immediately if you think you may miss a deadline and request an extension in writing.
- Does the 180-day internal appeal deadline apply to all plans?
- The 180-day deadline is the federal minimum for plans regulated by the ACA. Some plans may provide longer deadlines — always check your denial letter for the specific deadline that applies to your plan. ERISA plans (employer self-funded plans) also follow the 180-day minimum under DOL regulations.
- When does the appeal deadline clock start?
- For internal appeals, the 180-day clock starts from the date of the denial notice (the date on the denial letter). For external reviews, the clock typically starts from the date of the final internal denial decision. Always use the date on the denial letter, not the date you received it.
- Are expedited appeal deadlines different from standard deadlines?
- Yes. For expedited (urgent) internal appeals, the insurer must respond within 72 hours. For expedited external reviews, the IRO must also respond within 72 hours. The request for expedited review must be accompanied by your physician's certification that the standard timeline would seriously jeopardize your life or health.
Continue Your Research
- State-by-state appeal guide — state-specific resources and contacts.
- Internal vs. external appeal — understand the sequence of appeals and deadlines.
- Free appeal letter builder — start your appeal before the deadline.