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Health Appeal Map

Health insurance or Medicaid said no? Appeal deadlines and free help in your state

Pick your state to see who regulates your plan, how long you have to appeal and where to get free help.

External review means a doctor or reviewer outside your plan decides again. Internal appeal means your plan looks at its own decision again.

Checked against official sources: October 30, 2026.

Pick your plan type

Which kind of coverage was denied? The plan type decides which rules and deadlines apply.

Insurance I bought or got through work

Your state insurance rules may apply. First appeal to your plan, then ask for an outside review.

My employer pays claims itself (self-funded)

Federal rules apply, and most state insurance laws do not. Free help comes from the U.S. Department of Labor.

Medicaid / CHIP

You ask the state for a fair hearing. In a Medicaid health plan, you usually appeal to the plan first.

Marketplace (HealthCare.gov) decision

A decision about whether you can buy a plan or get financial help is appealed to the Marketplace.

How long do I have?Urgent care: faster decision Write my appeal Free help

Appeal deadlines are strict. If you are near a deadline or your care is urgent, call free help today.

Pick your state

State runs its own outside review
Federal process
Not covered yet

Tap a state to see how it handles outside review of denied claims.

States not covered yet

We have not finished checking these states against official sources. Until then, use the official pages and free help below:

New Hampshire: State insurance department · CMS help page for this state · LawHelp.org

Free help

Your state page lists free help near you. These national services can help too:

Free calculator and letters

Appeal deadline calculator

Dates from your notice: appeal, outside review, Medicaid hearing, Marketplace.

Letter: appeal to your plan

To the plan: your reasons, a faster decision if urgent, and your ongoing treatment.

Letter: ask for your claim file and criteria

Free copies of your file, the criteria used and the diagnosis and treatment codes.

Letter: ask for external review

A cover letter for the state form, or for the federal process.

Letter: Medicaid fair hearing request

To the state hearing agency, with boxes to keep your benefits and ask for a faster hearing.

Letter: appeal to your Medicaid health plan

To your Medicaid health plan within the 60-day rule, with a box to keep your benefits.

Checklist: what to gather before you appeal

Denial notice, explanation of benefits, doctor's letter, records and a call log.

Compare states

External review by state

Medicaid hearing deadlines

Marketplace appeals by state

Guides

Internal appeal or external review?

Urgent appeals

Self-funded employer plans

Medicaid hearings and keeping benefits

Marketplace eligibility appeals

Medicaid work rules in 2027

All state guides

Alabama

Outside review: Federal process

Medicaid hearing: 60 days

Alaska

Outside review: State program

Medicaid hearing: 30 days

Arizona

Outside review: State program

Medicaid hearing: 35 days

Arkansas

Outside review: State program

Medicaid hearing: 30 days

California

Outside review: State program

Medicaid hearing: 90 days

Colorado

Outside review: State program

Medicaid hearing: 60 days

Connecticut

Outside review: State program

Medicaid hearing: 60 days

Delaware

Outside review: State program

Medicaid hearing: 90 days

District of Columbia

Outside review: State program

Medicaid hearing: 90 days

Florida

Outside review: Federal process

Medicaid hearing: 90 days

Georgia

Outside review: Federal process

Medicaid hearing: 30 days

Hawaii

Outside review: State program

Medicaid hearing: 90 days

Idaho

Outside review: State program

Medicaid hearing: 30 days

Illinois

Outside review: State program

Medicaid hearing: 60 days

Indiana

Outside review: State program

Medicaid hearing: 33 days

Iowa

Outside review: State program

Medicaid hearing: 30 days

Kansas

Outside review: State program

Medicaid hearing: 33 days

Kentucky

Outside review: State program

Medicaid hearing: 30 days

Louisiana

Outside review: State program

Medicaid hearing: 30 days

Maine

Outside review: State program

Medicaid hearing: 60 days

Maryland

Outside review: State program

Medicaid hearing: 90 days

Massachusetts

Outside review: State program

Medicaid hearing: 60 days

Michigan

Outside review: State program

Medicaid hearing: 90 days

Minnesota

Outside review: State program

Medicaid hearing: 30 days

Mississippi

Outside review: State program

Medicaid hearing: 30 days

Missouri

Outside review: State program

Medicaid hearing: 90 days

Montana

Outside review: State program

Medicaid hearing: 90 days

Nebraska

Outside review: State program

Medicaid hearing: 90 days

Nevada

Outside review: State program

Medicaid hearing: 90 days

New Jersey

Outside review: State program

Medicaid hearing: 30 days

New Mexico

Outside review: State program

Medicaid hearing: 90 days

New York

Outside review: State program

Medicaid hearing: 60 days

North Carolina

Outside review: State program

Medicaid hearing: 30 days for services, 60 days for eligibility

North Dakota

Outside review: State program

Medicaid hearing: 30 days

Ohio

Outside review: State program

Medicaid hearing: 90 days

Oklahoma

Outside review: State program

Medicaid hearing: 30 days

Oregon

Outside review: State program

Medicaid hearing: 60 days for services, 90 days for eligibility

Pennsylvania

Outside review: State program

Medicaid hearing: 30 days

Rhode Island

Outside review: State program

Medicaid hearing: 30 days

South Carolina

Outside review: State program

Medicaid hearing: 30 days

South Dakota

Outside review: State program

Medicaid hearing: 30 days

Tennessee

Outside review: State program

Medicaid hearing: 40 days

Texas

Outside review: Federal process

Medicaid hearing: 90 days

Utah

Outside review: State program

Medicaid hearing: 30 days for services, 90 days for eligibility

Vermont

Outside review: State program

Medicaid hearing: 90 days

Virginia

Outside review: State program

Medicaid hearing: 30 days

Washington

Outside review: State program

Medicaid hearing: 90 days

West Virginia

Outside review: State program

Medicaid hearing: 90 days

Wisconsin

Outside review: Federal process

Medicaid hearing: 45 days

Wyoming

Outside review: State program

Medicaid hearing: 20 business days

Common questions

Which states use the federal process for outside review?

5 of the 50 states we cover use the federal process: Alabama, Florida, Georgia, Texas, Wisconsin. The other states run their own program; see each state page.

How long do I have to appeal a denied health claim?

You have at least 180 days (about 6 months) from when you receive the denial notice to file an internal appeal. Your plan can give you more time, not less.

How long do I have to ask for an outside review?

Under the federal process you have 4 months from the date you receive the denial or final appeal decision to ask for external review. If there is no matching date 4 months later, the deadline is the first day of the fifth month. If the last day is a Saturday, Sunday or federal holiday, it moves to the next business day. State programs must allow at least 4 months; some allow more.

How long do I have to ask for a Medicaid fair hearing?

Your state must give you a reasonable time to ask for a fair hearing, up to 90 days from the date the notice was mailed. Check your notice: your state's deadline may be shorter.

Can I keep my Medicaid benefits while I appeal?

If you ask for a hearing before the date the change takes effect, the state usually may not cut or end your services until the hearing decision. If you lose the hearing, the state may try to recover the cost of services you got only because of this rule.

Not about a denied claim? A medical bill you can't pay or think is wrong → Medical Bill Map. Medical debt in collections → Debt Collector Map. Anything else → robinclaim.com.

National rules that apply in every state

Appeal to your plan

You have at least 180 days (about 6 months) from when you receive the denial notice to file an internal appeal.
Law: 29 CFR 2560.503-1(h)(3)(i); 45 CFR 147.136(b)(2)(i), (b)(3)(i)
The plan must decide your appeal within 72 hours for urgent care, 30 days for care you have not received yet, and 60 days for care you already received.
Law: 29 CFR 2560.503-1(i)(2)

Outside (external) review

Under the federal process you have 4 months from the date you receive the denial or final appeal decision to ask for external review.
Law: 45 CFR 147.136(c)(2)(vi), (d)(2)(i)
The reviewer must decide within 45 days of getting a standard request, and within 72 hours for an expedited (urgent) request.
Law: 45 CFR 147.136(c)(2)(xii)-(xiii), (d)(2)(iii)(B)(6), (d)(3)(iv)
The decision is binding on the plan. If the reviewer rules for you, the plan must cover or pay right away.
Law: 45 CFR 147.136(c)(2)(xi), (d)(2)(iv)
The HHS-administered federal process is free. A state program or a plan's contracted reviewer may charge a fee, but not more than $25.
Law: HealthCare.gov, External Review

Employer plans that pay claims themselves

Many large employers pay claims themselves instead of buying insurance.

Law: 29 CFR 2590.715-2719(c)(1)(ii), (d); HealthCare.gov glossary: self-insured plan

Medicaid

Your state must give you a reasonable time to ask for a fair hearing, up to 90 days from the date the notice was mailed.
Law: 42 CFR 431.221(d)
If you ask for a hearing before the date the change takes effect, the state usually may not cut or end your services until the hearing decision.
Law: 42 CFR 431.230
Before it cuts or ends your benefits, the state must usually send you a notice at least 10 days before the change takes effect.
Law: 42 CFR 431.211

Surprise out-of-network bills

The No Surprises Act protects most people with insurance from surprise out-of-network bills for emergency care, some care at in-network hospitals and surgery centers, and air ambulance. A denial about whether these protections apply can go to external review. For questions or complaints, call the No Surprises Help Desk at 1-800-985-3059.

Law: 45 CFR 147.136(d)(1)(i)(B); CMS, Medical bill rights

Medicare

Medicare and Medicare Advantage plans have their own appeal process with up to 5 levels. Each decision letter tells you how to go to the next level. Your State Health Insurance Assistance Program (SHIP) gives free help: find it at shiphelp.org.

Law: Medicare.gov, Appeals

National help