My employer health plan denied prior authorization. How long do I have to appeal, and how fast must they decide?

Health insuranceAppealChecked Nov 5, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-05 · Source: eCFR · 29 CFR 2560.503-1(h)(3)(i) (row er-appeal-file) View original ↗

In short

You get at least 180 days to appeal.
Ask for your claim file. It is free.
The plan must decide in 72 hours if urgent, or in 30 to 60 days if not.

What this means

A group health plan must give you at least 180 days after you receive the denial to appeal [1].

On request and free of charge, you get reasonable access to, and copies of, all documents, records and other information relevant to your claim [2].

The plan must decide the appeal no later than 72 hours for urgent care, 30 days for a pre-service claim (15 days for each of two levels), and 60 days for a post-service claim (30 days for each of two levels) [3]. A plan may not require more than two appeals before you can bring a civil action under ERISA section 502(a) [4]. The Department of Labor's EBSA answers questions at 1-866-444-3272, and DOL says these time limits are counted in calendar days [5].

Your next step

+ deadline: file the appeal within the period in your denial notice, which must be at least 180 days [1]. Ask for your claim file at the same time [2].

Where this comes from (5)

[1] eCFR · 29 CFR 2560.503-1(h)(3)(i) (row er-appeal-file) · checked 2026-11-05
(3) 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] eCFR · 29 CFR 2560.503-1(h)(2)(iii) (row er-docs) · checked 2026-11-05
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] eCFR · 29 CFR 2560.503-1(i)(1)-(2) (row er-appeal-decide) · checked 2026-11-05
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 … not later than 30 days
[4] eCFR · 29 CFR 2560.503-1(c)(2) (row er-two) · checked 2026-11-05
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
[5] U.S. Department of Labor (EBSA) · Filing a Claim for Your Health Benefits (row er-ebsa) · checked 2026-11-05
contact the Department of Labor's Employee Benefits Security Administration (EBSA) at 1-866-444-3272 … The time limits are counted in calendar days, so weekends and holidays are included.

How we found this

We matched your question to 5 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-05.

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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