Question 1

How long do I have to file an internal appeal against a health-insurance denial?

Accepted Answer

At least 180 days from the denial notice (29 CFR §2560.503-1(h)(3)(i) (mirrored at 45 CFR §147.136(b)) — you have AT LEAST 180 days from the denial notice to file the internal appeal).

Question 2

Does my plan have 30 days to decide a pre-service claim appeal?

Accepted Answer

No — 29 CFR §2560.503-1(f)(2)(iii)(A) — pre-service claims decided within 15 DAYS (one 15-day extension possible). NOTE: 15, not 30 — the 30-day figure circulating online is the post-service window (primary text verified)

Question 3

How fast must an urgent-care appeal be decided?

Accepted Answer

Within 72 hours (29 CFR §2560.503-1(f)(2)(i) — urgent-care claims decided within 72 hours).

Question 4

What is the deadline to request external review after a final internal denial?

Accepted Answer

At least 4 months (45 CFR §147.136(c)(2)(vi) — request external review within AT LEAST 4 MONTHS of the final internal denial).

Question 5

Is the external reviewer's decision binding?

Accepted Answer

Yes — 45 CFR §147.136(c)(2)(xii)-(xiii) — the independent review organization decides within 45 days (72 hours expedited); its decision binds the plan

Claim type	Plan must decide within	Basis
Urgent care	72 hours	29 CFR §2560.503-1(f)(2)(i) — urgent-care claims decided within 72 hours
Pre-service	15 days	29 CFR §2560.503-1(f)(2)(iii)(A) — pre-service claims decided within 15 DAYS (one 15-day extension possible). NOTE: 15, not 30 — the 30-day figure circulating online is the post-service window (primary text verified)
Post-service	30 days	29 CFR §2560.503-1(f)(2)(iii)(B) — post-service claims decided within 30 days (one 15-day extension possible)

Denied a claim? Your appeal windows, and the deadline everyone gets wrong

The decision windows once you've filed

External review