How do I appeal my employer health plan's denial for pregnancy or birth care?

Health insuranceAppealChecked Nov 6, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: govinfo CFR 2024 · 29 CFR 2560.503-1 · § 2560.503-1(h)(2)(i), (h)(3)(i), (h)(4) View original ↗

In short

Your denial letter says how to appeal. Read it first.
A job-based health plan must give you at least 180 days to appeal.
Ask the plan for your claim papers. It is free.

What this means

If your health coverage comes through your job, the Department of Labor claims rule applies. The plan must give you at least 180 days after you get the denial notice to appeal [1]. You can ask the plan for copies of all the papers and records about your claim, and it cannot charge you for them [2].

After you appeal, the plan has a set time to answer. For care you already got, that is 60 days in total (30 days for each of two levels). For care you have not had yet, it is 30 days (15 days for each of two levels). For urgent care, it is 72 hours [3]. A plan may not make you file more than two appeals before you can go to court [4].

Your next step

Count 180 days from the day you got the denial letter. Send a written appeal and ask for your claim papers in the same letter.

Deadline: at least 180 days after you receive the denial (your plan may give more).

Check it yourself

The sources are about the federal rule for job-based plans. Pregnancy and birth are not mentioned in them, so they say nothing special about those claims. A plan that is not a private-employer plan (for example a government plan) may follow other rules - "Don't know yet". Your plan papers say which applies.

Where this comes from (4)

[1] govinfo CFR 2024 · 29 CFR 2560.503-1 · § 2560.503-1(h)(2)(i), (h)(3)(i), (h)(4) · 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;
[2] 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.
[3] govinfo CFR 2024 · 29 CFR 2560.503-1 · § 2560.503-1(i)(1)-(3) · checked 2026-11-06
not later than 72 hours after receipt of the claimant's request for review … not later than 30 days … not later than 15 days … not later than 60 days
[4] govinfo CFR 2024 · 29 CFR 2560.503-1 · § 2560.503-1(c)(2) · checked 2026-11-06
The claims procedures do not contain any provision, and are not administered in a way, that requires a claimant to file more than two appeals of an adverse benefit determination prior to bringing a civil action under section 502(a) of the Act;

How we found this

We matched your question to 4 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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