When waiting for a standard appeal could seriously jeopardize your health, your life, or your ability to regain maximum function — or when you are in the middle of urgent or ongoing treatment — you can request an expedited (urgent) appeal. The plan must decide much faster than a standard appeal, typically within about 72 hours. This letter invokes that urgency, asks for a fast written decision, and requests that an external review run at the same time so you do not lose time if the denial is upheld. The exact urgent-appeals phone number, fax, and address are on your denial letter — use the fastest channel they list.
Before you appeal
Move quickly and gather only what you need to show urgency:
- The denial letter or EOB with the denial reason and code.
- Your member ID, group number, and claim or authorization number.
- A statement from your treating physician certifying that the standard timeframe would seriously jeopardize your health or function (this is the key document).
- Brief clinical records showing the urgency or the ongoing nature of the care.
The letter
[Your full name]
[Your address]
[City, State ZIP]
[Phone] | [Email]
[Date]
[Insurance company - Appeals Department]
[Address from your denial letter]
Re: REQUEST FOR EXPEDITED (URGENT) APPEAL
Member: [Name] Member ID: [number] Group #: [number]
Claim/Authorization number: [number] Date(s) of service: [dates]
Denial date: [date] Denial reason/code: [as stated on the EOB]
To the Appeals Department:
I am requesting an EXPEDITED (urgent) appeal of the denial identified above. A
delay for a standard appeal could seriously jeopardize my health, my life, or
my ability to regain maximum function, or would subject me to severe pain that
cannot be adequately managed without the requested care.
My treating physician, Dr. [name], has certified that this situation is urgent
and that the standard appeal timeframe would be harmful. That certification is
enclosed.
Because this is urgent, I request a written decision as quickly as my plan
requires for expedited appeals, which I understand is generally within about
72 hours. I also request that an external review be initiated at the same time
as this internal appeal, so that no time is lost if the denial is upheld.
Enclosed in support:
- [Physician certification of urgency from Dr. [name]]
- [Relevant clinical records / test results]
- [Copy of the EOB / denial letter]
Please confirm receipt of this expedited request and notify me and Dr. [name]
of your decision in writing within the expedited timeframe. If you uphold the
denial, please send the specific reason and confirm that the simultaneous
external review is proceeding.
Thank you for your urgent attention.
Sincerely,
[Your signature]
[Your printed name]
How to send it
Use the plan’s fastest official channel — the urgent-appeals phone line, fax, or portal listed on your denial — and follow up in writing. You generally do not have to wait for the standard process to finish: for urgent care, you can pursue the internal appeal and an external review at the same time. Ask your doctor’s office to call the plan as well, since a physician’s urgency certification carries weight. Keep a dated copy of everything and note the date and time you submitted.
Notes. Under federal ACA rules, an expedited internal appeal is available when standard timeframes could seriously jeopardize your health or your ability to regain maximum function, or for ongoing urgent care, and is generally decided within about 72 hours; for urgent situations you may request the internal appeal and an external review simultaneously. A treating physician’s certification of urgency is what triggers the faster track. If your situation is not urgent, use the standard internal appeal letter instead; if the denial turns on whether the care was needed, see the medical-necessity appeal. This is general information, not legal or medical advice.