Missing a deadline is the easiest way to lose an otherwise winnable appeal, so pin down your dates first. For ACA-compliant plans the headline numbers are generally 180 days to file an internal appeal and 4 months to request external review. But the exact deadline on your own denial letter controls — different plan types use different clocks, and the letter reflects yours. Use the table below as orientation, then verify against your notice.
Typical deadlines at a glance
The figures below are typical for ACA-compliant plans; always confirm on your denial letter and plan documents.
| Step | Typical deadline / window | Notes |
|---|---|---|
| File internal appeal | Generally within 180 days of the denial notice | Counts from the date of the adverse determination |
| Insurer decision — pre-service | About 30 days | Care not yet received |
| Insurer decision — post-service | About 60 days | Bill for care already received |
| Insurer decision — urgent/expedited | About 72 hours | When delay could seriously harm your health |
| Request external review | Generally within 4 months of the final internal denial | Often a federal or state-run independent review |
| External review decision — standard | About 45 days | Independent reviewer, binding on the plan |
| External review decision — expedited | About 72 hours | For urgent situations |
| Medicare Advantage | Differs — file reconsideration generally within 60 days | See /guides/which-appeal-process/ |
| Medicaid/CHIP | Differs by state — often request a fair hearing within ~90 days | You may keep benefits during appeal if you act fast |
The denial letter controls
Treat the table as a map, not a guarantee. Self-funded employer plans (ERISA), Medicare, Medicaid, and short-term plans run on different rules, and even ACA plans can phrase deadlines slightly differently. The single source of truth is the deadline printed on your denial letter and your plan documents. If the letter is unclear, call the number on your insurance card and ask for the exact internal-appeal and external-review deadlines in writing.
How to ask for an expedited timeline
If waiting for the standard timeline could seriously jeopardize your health or your ability to regain function — or, for ongoing care, leave you in severe pain — you can generally request an expedited (urgent) appeal. Expedited decisions are typically due in about 72 hours rather than weeks. Say plainly in your request that the situation is urgent and, when possible, attach a short note from your provider supporting urgency. In many urgent cases you can pursue the internal appeal and external review at the same time rather than waiting for one to finish. See /guides/expedited-urgent-appeal/.
Count carefully
Deadlines generally run from the date of the notice, not the date you opened it, so do not let mail sit. File early when you can — submitting well before the deadline gives you room to add records or correct an address error without running out of time.
Notes. For ACA-compliant plans, internal appeals are generally due within 180 days of the denial and external review generally within 4 months of the final internal denial; standard insurer decisions typically run ~30 days pre-service, ~60 days post-service, and ~72 hours when expedited — but the controlling deadline is always the one on your denial letter, and Medicare and Medicaid differ. To decode your letter see /guides/read-your-denial-letter/, to draft your appeal see /guides/internal-appeal-letter/, and for the next stage see /guides/external-review-request/. This is general information, not legal, medical, or insurance advice.