Insurance Appeal Deadline Calculator
Free tool. Enter your denial date, state, and plan type — we'll calculate your internal appeal, external review, expedited review, and lawsuit deadlines instantly.
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How to Use
- Find your denial date. It's printed at the top of the denial letter, usually labeled "Date of Notice" or "Date of Determination."
- Know your plan type. Self-funded ERISA plans (most large-employer plans) follow federal rules. Fully-insured employer plans follow state rules. Marketplace plans follow ACA rules. Medicare and Medicaid have their own timelines.
- Match the denial reason. Medical necessity, prior authorization, and experimental/investigational are the most common — they all qualify for external review.
- File internal first, then external. Federal law requires you to complete your plan's internal appeal before requesting an external (independent) review.
State-Specific Rules
Some states have more generous deadlines or faster external-review processes. Highlights:
180 days internal. Independent Medical Review (IMR) via DMHC — file within 6 months of the final denial. Free to the consumer.
180 days internal. External appeal via DFS — file within 4 months of the final adverse determination. Expedited review available in 72 hours.
180 days internal. Independent Review Organization (IRO) via TDI — request within 4 months. Standard IRO decision in 20 days; urgent care in 72 hours.
180 days internal. External review via OIR — file within 4 months of the final denial.
For fully-insured plans in other states, always verify the exact deadline with your state insurance commissioner — deadlines can be as short as 60 days in a handful of states.
What to Do If You're Close to a Deadline
- Request an expedited appeal. If a delay would seriously jeopardize your health, federal law requires insurers to respond within 72 hours.
- File in writing, with proof of mailing. Certified mail with return receipt, or an email with a read receipt — both are acceptable in most plans.
- Ask for an extension in writing. Some insurers will grant a short extension for good cause. Document the request.
- Contact your state insurance commissioner. They can intervene on tight-deadline cases, especially for fully-insured and Marketplace plans.
- Get a patient advocate. The Patient Advocate Foundation (patientadvocate.org) and Triage Cancer offer free help.