Appeal
Also called: insurance appeal
Clinical reviewer: Elena Gizzi, MSN, RN · Last checked September 16, 2026
How do you appeal an insurance denial?
Appeal refers to a request to your health insurer or the Health Insurance Marketplace to review a decision that denied a benefit or payment. You can first ask the insurer to review its own decision through an internal appeal, then bring an unresolved denial to an independent third party through external review.
How does an internal appeal work?
If your plan refuses to pay a claim, you have the right to appeal and have it reviewed by a third party [1]. You must file an internal appeal within 180 days of receiving the denial notice, and the insurer must complete the appeal within 30 days for a service you have not yet received, such as a prior authorization request, 60 days for services already received, or, for urgent care, as fast as your condition requires and within 4 business days [2]. Submit anything you want considered, such as a letter from your doctor [2].
What is external review, and when can you use it?
If the internal appeal doesn't resolve things, you can request external review, and the insurer no longer has the final say over whether to pay the claim [3]. You must file within 4 months of the final denial notice; standard reviews are decided within 45 days, and expedited reviews within 72 hours [3]. The decision is binding on the insurer, and the review can cost you no more than $25 [3].
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This entry is for education and is not medical advice. Talk with a licensed clinician about your own situation before starting, stopping, or changing any treatment.
