Health insurance appeal deadline calculator
Estimate internal appeal, external review, and urgent filing dates from your denial.
Enter the date on your denial or adverse benefit determination to estimate filing windows. Many fully insured and ACA marketplace plans allow about 180 days for a standard internal appeal, about four months for external review after a final internal denial, and as little as 72 hours for urgent pre-service denials. Your notice controls; Medicare, Medicaid, and self-funded ERISA plans use different rules.
- Plan-type aware
- Calendar export tips
- Free
Example
ERISA plan, denial March 15, 2026, standard internal appeal → illustrative deadline about September 11, 2026 (180 days). Toggle urgent for expedited hours/days per 29 CFR 2560.503-1.
Illustrative only. Your adverse benefit determination letter controls. Cite 29 CFR 2560.503-1 (many ERISA plans) and 45 CFR 147.136 (many ACA plans) when your notice is silent.
Complete guide
How to use Deadlines in your appeal workflow
How it works
- Enter the date printed on your adverse benefit determination or denial letter.
- Select plan type (ACA, ERISA, Medicare, Medicaid, TRICARE) and optional state for external review context.
- Toggle urgent/expedited when delay could seriously jeopardize health or the service is pre-service.
- Download an .ics calendar reminder for the illustrative internal deadline and verify against your notice.
Why the denial date matters
Most commercial internal appeals start counting from the date the plan issued the adverse benefit determination, not the date you opened the envelope. ERISA claims procedure rules require written notice for many group plans (29 CFR 2560.503-1). ACA-related plans also require clear appeal rights in notice (45 CFR 147.136). If the notice date is wrong, you may request clarification in writing while preserving your rights.
Standard vs expedited clocks
Standard pre-service denials often allow a longer window to request review. When care has not been provided and delay could seriously jeopardize life or health, many plans must offer an expedited review with a much shorter response time. Mark urgent only when your clinical situation fits the plan's definition — exaggerating urgency can hurt credibility.
External review timing
External review generally begins only after you exhaust internal appeals unless state law allows concurrent filing for certain benefits. The calculator adds illustrative days after the internal window for planning — your final denial letter lists the actual external review deadline and the approved reviewer organization.
Plan type selector and state notes
Each plan profile applies different illustrative day counts drawn from common federal frameworks (29 CFR 2560.503-1 for many ERISA plans, 45 CFR 147.136 for many ACA plans, CMS rules for Medicare). Selecting a state displays external review education from that state’s guide — not a substitute for your MCO or insurer notice.
Calendar export (.ics)
Use Add to calendar to create a private reminder on your phone or desktop. Set a second alert several days before the illustrative deadline so you can assemble records. AppealFlow does not store your dates server-side.
Worked example: estimating a 180-day internal window
Your commercial plan sends an adverse benefit determination dated March 15, 2026 denying physical therapy as not medically necessary. The notice says you may request an internal appeal within 180 days. Adding 180 calendar days to March 15 lands on September 11, 2026 (verify with your plan — some policies use business days or a fixed date on the form). If you need continued care while waiting, ask whether the plan offers an expedited review and document any worsening symptoms. If the internal appeal is upheld, the same notice often explains whether you may request external review and which state or federal program applies. Save portal uploads, fax confirmations, and certified mail receipts.
Appeal deadlines by plan type (reference)
Deadlines are plan-specific. The table summarizes common federal frameworks cited on many notices. Your adverse benefit determination letter controls filing dates and channels.
| Plan type | Internal appeal | External review | Urgent / expedited |
|---|---|---|---|
| ACA marketplace / fully insured individual & small group | Often 60–180 days from the adverse determination (check notice). ACA internal claims and appeals rules require written notice of rights. | After exhausting internal appeals, many enrollees may request external review; federal rules set minimum external review rights for qualifying plans (see 45 CFR 147.136). | Urgent medical situations may qualify for expedited review; many plans must respond within 72 hours when delay could seriously jeopardize health (45 CFR 147.136(b)(3) framework). |
| Self-funded employer plan (ERISA) | 29 CFR 2560.503-1 requires a reasonable opportunity for a full and fair review; many plans allow about 180 days to request review of an adverse benefit determination unless the plan document grants longer. | External review rights depend on plan design and state law for insured portions; many ERISA plans use independent review vendors after internal exhaustion. | Expedited review must be available when the timeframe for a standard review could seriously jeopardize life or health (29 CFR 2560.503-1(h)(3)(i)). |
| Original Medicare (Part A & B) | Medicare uses redetermination (Level 1) by the Medicare Administrative Contractor — typically 120 days from the date of the initial determination on the MSN. | Reconsideration (Level 2), ALJ hearing, and further levels follow CMS Medicare appeals guidance — not the same clocks as commercial insurance. | Expedited Medicare determinations exist for certain hospital and SNF situations; follow instructions on the MSN. |
| Medicare Advantage (Part C) | Organization determination and plan-level appeals follow CMS Medicare Advantage rules; use the plan's forms and clocks on the denial. | After plan-level appeals, enrollees may request CMS review or, for some issues, state external review when applicable. | Part C plans must offer expedited reviews for urgent requests per CMS marketing/appeals requirements. |
| Medicare Part D (prescription drugs) | Coverage determinations and exceptions use PBM/plan Part D forms; standard determination timeframes are set in CMS Part D regulations. | Appeal to the Independent Review Entity (IRE) after plan-level denial of a standard or expedited determination. | Expedited exceptions and appeals exist when waiting could seriously harm health; request expedited processing in writing. |
| Medicaid / CHIP (state) | Each state Medicaid agency sets fair hearing and appeal timelines; use the notice from your managed care plan or state agency. | State fair hearing after managed care appeal exhaustion; timelines vary by state and benefit type. | Many states allow expedited hearings when delay would jeopardize health; cite urgency on the request form. |
Cite 29 CFR 2560.503-1 for many ERISA group health plans and 45 CFR 147.136 for many non-grandfathered individual/small group plans. Medicare and Medicaid use separate statutes and forms.
Common mistakes
- Treating an illustrative calculator result as a legal deadline without reading your notice.
- Filing with the medical claims address when the denial is a pharmacy benefit determination.
- Skipping the internal appeal and going straight to external review before the notice allows it.
What to do next
- Save proof of filing (portal screenshot, fax confirmation, or certified mail receipt).
- If the plan requests more records, respond within the timeframe on the follow-up letter.
- When internal appeals are exhausted, read your notice for external review or state complaint rights.
- Need deadlines, evidence lists, and filing checklists in one download? Consider the matching AppealFlow pack on the pricing page (document prep only).
- Matching paid document pack
- General appeal letter generator
- Denial code lookup