How do I appeal a health insurance denial?

Health insuranceAppealChecked Nov 6, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: HealthCare.gov · Internal appeals View original ↗

In short

Look at your denial letter. It says how to appeal.
You usually have 180 days to appeal. Do not wait.
Keep copies of everything you send.

What this means

A health plan must explain a denial in writing. If you bought your plan on the marketplace, HealthCare.gov says you have 180 days (6 months) after the denial notice to file an internal appeal [1]. If your plan comes through a job, the federal claims rule says the plan must give you at least 180 days after the denial to appeal [2].

You may ask the plan, free of charge, for copies of the documents and records it used for your claim [3]. Ask for them in writing, then use them in your appeal.

Your next step

Find the date on your denial letter and count 180 days from the day you received it. Write your appeal and ask for your claim documents in the same letter.

Deadline: 180 days after you receive the denial notice.

Check it yourself

Your own denial letter and plan papers say which rules apply to your plan. Marketplace plans are covered by HealthCare.gov; job-based plans by the Department of Labor rule above. The sources do not say what happens in a plan that follows other rules (for example some government plans) — "Don't know yet".

Where this comes from (3)

[1] HealthCare.gov · Internal appeals · checked 2026-11-06
You must file your internal appeal within 180 days (6 months) of receiving notice that your claim was denied.
[2] govinfo CFR 2024 · 29 CFR 2560.503-1 · § 2560.503-1(h)(3)(i) · checked 2026-11-06
Group health plans. … (i) Provide claimants at least 180 days following receipt of a notification of an adverse benefit determination within which to appeal the determination;
[3] govinfo CFR 2024 · 29 CFR 2560.503-1 · § 2560.503-1(h)(2)(iii)-(iv) · checked 2026-11-06
Provide that a claimant shall be provided, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the claimant's claim for benefits.

How we found this

We matched your question to 3 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-06.

What we don’t know yet

Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.

Every answer is checked against the official rule it quotes.

Information only — not legal advice. Your plan, insurer or agency decides.

This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.

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