The short version
A denial is not the final word. It is the start of an appeal process with a deadline, and the deadline depends on your plan type. Find the date on your denial letter, count your window, and file in writing with records attached. A large share of denials are overturned when the treating provider's records go in with the appeal.
Build your appeal letter and deadline, freeThe calculator uses your plan type and denial date. Nothing you type leaves your device.
Appeal deadlines by plan type
| Plan type | Time to appeal after the denial |
|---|---|
| Private or employer plan, and Marketplace plans | 180 days |
| Medicare Advantage | 60 days |
| Original Medicare | 120 days |
| Medicaid | 60 days, and you can also request a state fair hearing |
Your denial letter states your exact deadline. Use the letter if it differs from this table.
What to gather before you write
- A copy of the denial letter
- A letter from the treating doctor explaining why the care was needed, with dates and prior treatments tried
- Office notes, test results, and records that support the service
- The plan page or policy section that covers this type of care, if you have it
- For a missing authorization denial: any record of the provider requesting authorization, and whether the care was urgent
How the appeal letter should read
- Identify yourself, the member ID, the claim number, and the date of service.
- State plainly that you are appealing the denial and name the reason the plan gave.
- Answer that reason directly with facts and records, not frustration.
- Ask the plan to identify the clinical criteria it applied and the reviewer who made the decision.
- Close with a request for a full and fair review and a written decision.
The free builder on DueEasy drafts this letter from your denial details and prints your exact deadline next to it.
Start the appeal builderIf the final appeal still says no
Most plans owe you an independent external review after a final denial. You generally have 4 months from the final denial to request it, an outside reviewer decides, and the decision binds the plan. The deadline calculator on DueEasy covers that date too, in the section called "If you hit a wall."