My health plan denied prior approval for care. How do I appeal, and how fast?

Health insuranceAppealChecked Nov 6, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: HealthCare.gov · Internal appeals · There are 3 steps … · How long does an internal appeal take? View original ↗

In short

You have 180 days (6 months) to appeal.
For care you have not had yet, the appeal must finish in 30 days.
If the care is urgent, you can ask for an outside review at the same time.

What this means

HealthCare.gov says you have 180 days (6 months) to file an internal appeal. The time starts when you get the notice that your claim was denied. An appeal for a service you have not received yet must be finished within 30 days [1]. In urgent cases you may ask for an internal appeal and an outside review at the same time. The decision must come as fast as your health requires, and within 4 business days at most [2].

If you bought a plan on your own (not through a job), the insurer may have only one level of internal appeal before its final decision [3].

Your next step

File your appeal within 180 days of receiving the denial.

Deadline: 180 days.

Check it yourself

HealthCare.gov gives 4 business days at most for an urgent appeal decision. Whether a shorter time applies to your plan: "Don't know yet" from these sources.

Where this comes from (3)

[1] HealthCare.gov · Internal appeals · There are 3 steps … · How long does an internal appeal take? · checked 2026-11-06
You must file your internal appeal within 180 days (6 months) of receiving notice that your claim was denied. … Your internal appeal must be completed within 30 days if your appeal is for a service you haven’t received yet.
[2] HealthCare.gov · Internal appeals · What if my care is urgent and I need a faster decision? · checked 2026-11-06
You may file an internal appeal and an external review request at the same time. A final decision about your appeal must come as quickly as your medical condition requires, and at least within 4 business days after your request is received.
[3] govinfo · 45 CFR 147.136 · § 147.136(b)(3)(ii)(G) · checked 2026-11-06
a health insurance issuer offering individual health insurance coverage must provide for only one level of internal appeal before issuing a final determination.

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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