Appeal deadlines in Virginia

State outside review (120 days); Medicaid hearing deadline 30 days.

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.

Deadlines at a glance in Virginia

Outside review: 120 days
Hearing deadline: 30 days
Then a state hearing: 120 days
Appeal deadline – Virginia's Insurance Marketplace: 90 days

How each deadline is counted in Virginia

Time to file

Virginia's statute leaves the filing time to Bureau of Insurance rules. Use the deadline on your denial notice; federal rules give at least 180 days for most plans.

Law: Va. Code 38.2-3558, 38.2-5904

Deadline to ask

A complete request must reach the Bureau of Insurance within 120 days after the date you received notice of your right to external review. The reviewer decides a standard review within 45 days.

Law: Va. Code 38.2-3557, 38.2-3560, 38.2-3561, 38.2-3562, 38.2-3563, 38.2-3564, 38.2-3569; Va. Code 14VAC5-216

The deadline runs from

The date you receive the notice of your right to external review (usually in the insurer's final denial)

Hearing deadline

The date you receive the written notice (presumed 5 days after mailing)

Keeping your benefits during the appeal

You can ask to keep your coverage during the appeal if you file before the date coverage ends or within 10 days of the date on the notice. You must ask for it; it is not automatic.

How long do I have? Deadline calculator

Virginia · Appeal deadline calculator

If you miss a deadline

Medicaid

If you file after the deadline without a reason, DMAS sends you a letter asking for 'good cause', and a hearing officer decides whether to accept it. There is no good cause for late MCO appeals, which have a 120-day deadline that cannot be extended.

Medicaid health plan (managed care) in Virginia

The 120 days cannot be extended; there is no good cause for late MCO appeals.

Law: 12VAC30-110; 42 CFR 438.402

Medicaid

If you lost coverage for not completing a renewal or sending renewal verifications, you have 90 days after you lost coverage to return the renewal paperwork (this is a renewal step, not an appeal).

Law: 12VAC30-110-35, -100, -160

Sources

The official sources for Virginia are listed on the Virginia page.

National rules that apply in every state

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.

Law: 29 CFR 2560.503-1(h)(3)(i); 45 CFR 147.136(b)(2)(i), (b)(3)(i)

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.

Law: 45 CFR 147.136(c)(2)(vi), (d)(2)(i)

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.

Law: 42 CFR 431.221(d)

You generally have 90 days from the date of your Eligibility Notice to appeal. If you are late, explain why when you file; you may be able to get an extension.

Law: 45 CFR 155.520(b), (d)(2)(i)(D); HealthCare.gov, What can I appeal?