Health insurance or Medicaid said no in Arizona? Deadlines and free help

In Arizona, your health plan is regulated by Arizona Department of Insurance and Financial Institutions (DIFI), if it is a state-regulated plan.

Arizona runs its own independent review of denials: External independent review. You generally 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.

Medicaid / AHCCCS (Arizona Health Care Cost Containment System)

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 decisionWrite my appealFree help

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 Arizona?

Appeal to your plan
At least 180 days from receipt of the denial (federal rule)
Outside review
4 months
Hearing deadline
35 days
Appeal to the plan first
60 days (federal rule)
Appeal deadline – HealthCare.gov
90 days (federal rule)

All the details →

How long do I have? Deadline calculator

How do I know which plan type I have?

Step 1: Appeal to your plan in Arizona

What it is called: Initial appeal (and, for some group plans, a voluntary internal appeal)

For care you have not received yet, the insurer must send a written decision within 30 days after it gets your appeal; for a claim for care already provided, within 60 days. If your group plan also offers a voluntary second internal appeal, each level must be decided within 15 days (30 days for claims already provided), and you must ask for it in writing within 60 days after you receive the first appeal decision. If your treating provider certifies in writing that waiting could cause a significant negative change in your condition, you can get an expedited medical review decided within 72 hours, then an expedited appeal decided within 3 business days. Every decision must state the basis, criteria and clinical reasons. If the insurer does not follow these rules, you are treated as having finished the internal appeals and can go to external review.

Law: A.R.S. 20-2533(C), (D), (F); A.R.S. 20-2534; A.R.S. 20-2535(A); A.R.S. 20-2536(A)

All the details →

Step 2: Outside review in Arizona

External independent review

Deadline to ask: 4 months.

All the details →

Urgent care in Arizona: faster decisions

Outside review

In urgent cases (after an expedited appeal, for denied care while you are still hospitalized after emergency services, or when an admission or ongoing treatment is being cut short), the independent reviewer must decide within 72 hours after it gets the case, and DIFI sends the decision within 1 business day after that. For an experimental or investigational denial, you may ask orally if your doctor certifies in writing that the treatment would be significantly less effective if not started promptly.

Law: A.R.S. 20-2533(H), (J), 20-2537, 20-2538 (as amended by Laws 2024, ch. 178 (HB 2599), effective January 1, 2025)

Standard: 21 days; Urgent: 72 hours

Medicaid

For eligibility appeals, you can ask for an expedited appeal with a statement from a medical provider that you have (or cannot schedule) a procedure or treatment, have no insurance to cover most of it, and that waiting 90 days or less would put your life, health or ability to regain full function at serious risk. Expedited eligibility appeals must be resolved within 7 working days.

Law: 42 CFR 431.220-431.221

Complaints about your plan in Arizona

For other problems with an insurer, you can contact the Arizona Department of Insurance and Financial Institutions consumer assistance office at 602-364-3100 (Spanish 602-364-2977). If your complaint is about a denial, DIFI will require you to use the health care appeals process.

Law: A.R.S. 20-2533(K)

difi.az.gov

Medicaid (AHCCCS (Arizona Health Care Cost Containment System)) denials in Arizona

Who holds the hearing: Office of Administrative Hearings (for AHCCCS decisions) or DES Office of Appeals (for DES eligibility decisions); service appeals go through the AHCCCS Office of the General Counsel.

Hearing deadline: 35 days

All the details →

Marketplace decisions in Arizona

Arizona uses HealthCare.gov. Appeals go to the federal Marketplace Appeals Center.

HealthCare.gov

1-855-231-1751

Other rights in Arizona

Long time to start an internal appeal

Arizona gives you up to two years after a denial to ask your insurer for an initial appeal, much longer than the federal minimum of 180 days.

Law: A.R.S. 20-2535(A)

Who reviews medical appeals; new evidence

Appeals about medical necessity, setting, level of care or experimental treatment must be decided by a licensed physician or other qualified health care professional. Before a final internal denial that relies on new evidence, the insurer must give you that evidence free of charge, early enough for you to respond. No minimum claim amount can be required before you appeal.

Law: A.R.S. 20-2533(A), (L), (M)

How long do I have? Deadline calculator

Pick your plan type and enter the dates on your notice. We count from the rules in Arizona and the federal rules.

Worked out in your browser. Nothing you enter here is saved or sent.

If you are not sure when it arrived, use the date printed on the notice. That date is never later than the day it arrived.

Choose what was decided and enter the date on your notice

We add the number of days or months from the law to your date. Nothing is saved.

Write my appeal: free letters

Free help in Arizona

Good to know in Arizona

  • Since January 1, 2025, Arizona's health care appeals law has been rewritten: the 'informal reconsideration' and 'formal appeal' were replaced by an initial appeal and an optional voluntary internal appeal.

    Law: Laws 2024, ch. 178, HB 2599

  • In Arizona you send your external review request to your insurer's utilization review agent, which must forward it to DIFI within 5 business days.

    Law: A.R.S. 20-2537(B)-(C)

  • AHCCCS eligibility appeals must be received within 35 calendar days of the date on the decision letter, shorter than the federal 90-day maximum.

Changes in 2024–2026

Laws 2024, ch. 178, effective January 1, 2025, rewrote A.R.S. 20-2531 to 20-2542: new levels of review (initial appeal, optional voluntary internal appeal, external independent review), 30/60-day decision deadlines, 72-hour expedited medical review, the right to new evidence before a final denial, and 3-year record keeping. HHS lists Arizona's state external review process as effective 1/1/2025.

Law: HB 2599

Questions about appeals in Arizona

How long do I have to appeal a health insurance denial in Arizona?

Arizona law gives you up to two years after the denial to ask for an initial appeal. You can ask orally or in writing. 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 Arizona?

External independent review. Send a written request for external independent review to your insurer's utilization review agent (the contact named in your plan's appeal information packet and denial letter), with any documents that support your request. Within 5 business days the utilization review agent must acknowledge it and send your file to DIFI. You then have 5 business days after receiving the acknowledgment to send more written evidence to DIFI.

Is outside review free in Arizona?

You do not pay for the external independent review. Your insurer's appeal information packet must say that you are not responsible for its costs.

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

35 days. The date on the decision letter (eligibility appeals); the agency must receive your request by the 35th calendar day

Can I keep my Medicaid benefits while I appeal in Arizona?

To keep receiving a service while you appeal, file the appeal before the day the reduction, suspension or termination takes effect. If there are fewer than 10 days between the notice date and the effective date, file within 10 days from the notice date.

Who regulates health insurance in Arizona?

Arizona Department of Insurance and Financial Institutions (DIFI).

Not about a denied claim?

Nearby states

Sources

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