Health insurance or Medicaid said no in Alabama? Deadlines and free help
In Alabama, your health plan is regulated by Alabama Department of Insurance (ALDOI), Consumer Services, if it is a state-regulated plan.
Alabama uses the federal process for independent review of denials. You have 4 months to ask for it.
External review means a doctor or reviewer outside your plan decides again. Internal appeal means your plan looks at its own decision again.
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.
Alabama Medicaid
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.
Checked against official sources: October 30, 2026.
Appeal deadlines are strict. If you are near a deadline or your care is urgent, call free help today.
How long do I have in Alabama?
- Appeal to your plan
- At least 180 days from receipt of the denial (federal rule)
- Outside review
- 4 months (federal rule)
- Hearing deadline
- 60 days — The date the notice of action is mailed (Medicaid must RECEIVE your written request within 60 days)
- Keeping your benefits during the appeal
- If Medicaid is ending your eligibility and it receives your fair hearing request within 10 days of the date of the notice of action, your benefits may continue until the hearing decision, unless you cause unnecessary delays.
- Appeal deadline – HealthCare.gov
- 90 days (federal rule)
How do I know which plan type I have?
- Alabama Department of Insurance (ALDOI), Consumer Services · 1-800-433-3966 (334-241-4141) · Complaint form
Health insurance policies and HMOs subject to Alabama insurance law (plans you buy yourself or get from an employer that does business only in Alabama)
How to tell which agency regulates your plan
Insurance you bought yourself, or got from an employer that does business only in Alabama, is handled by the Alabama Department of Insurance. If your employer's plan is self-funded, your employer runs it and ALDOI cannot help; contact your employer or the U.S. Department of Labor.
Step 1: Appeal to your plan in Alabama
What it is called: Internal appeal with your insurer
- Time to file
Alabama does not give a longer time on the insurance department's pages. Use the deadline on your denial notice; federal rules give at least 180 days for most plans.
Federal rules set the internal appeal deadlines and decision times for Alabama plans.
Law: 45 CFR 147.136 (see national rules)
Step 2: Outside review in Alabama
- Program
Federal external review (HHS-administered process or the insurer's contracted independent review organization)
- Who runs it
- U.S. Department of Health and Human Services (federal external review process): Insured plans in Alabama, which uses the federal process
- Deadline to ask
Federal rule: at least 4 months.
Alabama uses the federal external review process. The federal deadline and rules apply.
- Do I have to appeal to my plan first?
Federal rules apply.
- Cost
Federal rules apply.
Federal rule: 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
- What can be reviewed
Federal rules apply.
- Is the decision final?
Federal rules apply.
- How to ask
Follow the external review instructions on your insurer's final denial letter, which will point you to the federal process.
Only for plans that use the HHS-administered process. Ask your plan, or check your denial notice, to find out.
maximusferp.my.site.com · 1-888-866-6205 · MAXIMUS Federal Services, 3750 Monroe Avenue, Suite 705, Pittsford, NY 14534
Urgent care in Alabama: faster decisions
Outside review
Federal rules apply.
Complaints about your plan in Alabama
First contact your insurance company or agent. If that does not solve it, file a complaint with ALDOI online or with its PDF Request for Assistance form. Include your name, address and phone, the company or agent, your policy number, any claim number, and a description of the problem. ALDOI sends your complaint to the company, reviews its response and can require corrective action. ALDOI cannot help if you have an attorney, cannot give legal or medical advice, and cannot help with self-funded employer plans.
Medicaid (Alabama Medicaid) denials in Alabama
Who holds the hearing: Alabama Medicaid Agency, Fair Hearings (Hearing Officer). Eligibility complaints are sent to the agency that made the eligibility decision (for example, the Social Security Administration for SSI-based Medicaid), which holds the hearing under its own procedures.
Hearing deadline: 60 days
Marketplace decisions in Alabama
Alabama uses HealthCare.gov. Appeals go to the federal Marketplace Appeals Center.
How long do I have? Deadline calculator
Pick your plan type and enter the dates on your notice. We count from the rules in Alabama and the federal rules.
Write my appeal: free letters
Free help in Alabama
- Alabama Department of Insurance, Consumer Services · 1-800-433-3966
Listed by HHS for questions about insurance you bought yourself or got from an Alabama-only employer; takes complaints about insurers. - Legal Services Alabama · 1-866-456-4995
- CMS help page for this state
- LawHelp.org
- Your state's Consumer Assistance Program (CAP) or insurance department
- U.S. Department of Labor, Employee Benefits Security Administration (EBSA) · 1-866-444-3272
- HealthCare.gov Marketplace Call Center and local help · 1-800-318-2596
- CCIIO Health Insurance Assistance Team · 1-888-393-2789
- Legal Services Corporation (LSC) - Find legal aid
Good to know in Alabama
- Alabama is one of the states that use the federal external review process instead of a state program (CMS CCIIO, State External Appeals Review Processes).
- Alabama Medicaid gives 60 days from the date the notice is mailed to request a fair hearing, and the request must be received in that time.
Law: Ala. Admin. Code 560-X-3-.03(3)
- Since July 13, 2026, Alabama Medicaid accepts fair hearing requests by mail, email or phone, but not by voicemail.
Law: Ala. Admin. Code 560-X-3-.08
Changes in 2024–2026
Alabama Medicaid amended its fair hearing rules effective July 13, 2026. Alabama has not expanded Medicaid, so the 2027 expansion-adult work requirement does not apply to its current Medicaid groups.
Law: Ala. Admin. Code 560-X-3-.03 amended
Questions about appeals in Alabama
How long do I have to appeal a health insurance denial in Alabama?
Alabama does not give a longer time on the insurance department's pages. Use the deadline on your denial notice; federal rules give at least 180 days for most plans. You have at least 180 days (about 6 months) from when you receive the denial notice to file an internal appeal.
How do I get an outside (external) review in Alabama?
Follow the external review instructions on your insurer's final denial letter, which will point you to the federal process.
Is outside review free in Alabama?
Federal rules apply.
How long do I have to ask for a Medicaid fair hearing in Alabama?
60 days. The date the notice of action is mailed (Medicaid must RECEIVE your written request within 60 days)
Can I keep my Medicaid benefits while I appeal in Alabama?
If Medicaid is ending your eligibility and it receives your fair hearing request within 10 days of the date of the notice of action, your benefits may continue until the hearing decision, unless you cause unnecessary delays. If you lose, you may have to pay back benefits received.
Who regulates health insurance in Alabama?
Alabama Department of Insurance (ALDOI), Consumer Services. Insurance you bought yourself, or got from an employer that does business only in Alabama, is handled by the Alabama Department of Insurance. If your employer's plan is self-funded, your employer runs it and ALDOI cannot help; contact your employer or the U.S. Department of Labor.