Questions & answers · Health insurance
My marketplace (ACA) plan denied a claim. How do I file an internal appeal?
Health insuranceAppealChecked Nov 5, 2026
From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-05 · Source: HealthCare.gov · Internal appeals (row aca-hc-int) View original ↗
In short
- File your appeal within 180 days of the denial.
- Ask to see your claim file during the appeal.
- The plan must decide in 30 days, or 60 days for care you already got.
What this means
HealthCare.gov says you must file your internal appeal within 180 days (6 months) of receiving notice that your claim was denied [1]. The internal appeal must be completed within 30 days for a service you haven't received yet, and within 60 days for a service you've already received [1].
An individual plan may have only one level of internal appeal before its final decision [2].
During the appeal you may review the claim file. The plan must give you, free of charge, any new evidence or new rationale it uses, and on request the diagnosis and treatment codes with their meanings [3].
If the plan doesn't follow these rules, you are generally treated as having finished internal appeals and may go to external review [4]. There is an exception for very small (de minimis) mistakes that don't harm you and that the plan shows were for good cause or beyond its control. The exception does not apply to a pattern of mistakes [4].
Your next step
+ deadline: file the internal appeal within 180 days of the denial notice [1].
Where this comes from (4)
[1] HealthCare.gov · Internal appeals (row aca-hc-int) · checked 2026-11-05
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. Your internal appeals must be completed within 60 days if your appeal is for a service you've already received.
[2] eCFR · 45 CFR 147.136(b)(3)(ii)(G) (row aca-indiv-one) · checked 2026-11-05
a health insurance issuer offering individual health insurance coverage must provide for only one level of internal appeal before issuing a final determination.
[3] eCFR · 45 CFR 147.136(b)(2)(ii)(C), (E)(2) (row aca-file) · checked 2026-11-05
The plan or issuer must provide the claimant, free of charge, with any new or additional evidence considered, relied upon, or generated by the plan or issuer … upon request, the diagnosis code and its corresponding meaning, and the treatment code and its corresponding meaning
[4] eCFR · 45 CFR 147.136(b)(2)(ii)(F) (row aca-deemed) · checked 2026-11-05
In the case of a plan or issuer that fails to strictly adhere to all the requirements of this paragraph (b)(2) with respect to a claim, the claimant is deemed to have exhausted the internal claims and appeals process … except as provided in paragraph (b)(2)(ii)(F)(2) … Accordingly the claimant may initiate an external review … (2) … de minimis violations that do not cause, and are not likely to cause, prejudice or ha…
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 2026-11-05.
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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