Timeline of the Health Insurance Claim Appeals Process - What Can You Expect and How Long Will it Take?
- Ashlynn Moore
- 3 days ago
- 2 min read
Getting a denial from your health insurance can be frustrating—but it’s not the end of the road. Whether it’s a denied claim, a service that wasn’t pre-approved, or a medication not covered, you have the right to appeal. Here’s a simple breakdown of what the process typically looks like and how long each step might take.
Step 1: Understand the Denial (1–7 Days)
You’ll receive a denial letter or Explanation of Benefits (EOB) that outlines what was denied and why. Review this carefully—it’s your roadmap for what comes next. If anything’s unclear, call your insurance company or ask your agent for help decoding it.
Step 2: Request an Internal Appeal (7–30 Days to Submit)
You usually have 180 days from the denial to request an internal appeal. That means your insurer will take another look at the decision. You (or your provider) will need to submit:
A written request for appeal
Any additional documentation (like medical records, letters from your doctor, or test results)
The denial letter
Pro tip: The sooner you send this, the sooner they can review it.
Step 3: Internal Review by the Insurance Company (30–60 Days)
Once they receive your appeal, the insurance company typically has:
30 days to decide on appeals for services you haven’t received yet
60 days for appeals on services you already received
They may contact your doctor for more info or send you a written decision when they’ve made their final call.
Step 4: Marketplace Review (If Needed – Up to 60 Days)
If your internal appeal is denied, you may request an Marketplace review. This is available in most cases, and the insurer must honor the reviewer’s decision.
You typically have 4 months from the final internal appeal denial to request this.
The external reviewer usually has up to 60 days to make a decision.
*Emergency or Expedited Claim Appeals (72 Hours or Less)
If your health is at serious risk, you can request an expedited appeal. These are reviewed quickly—within 72 hours, sometimes even faster. This is used exclusively for emergencies and are reviewed on a case by case basis.
Total Timeline: 1–6 Months (Usually)
If everything goes smoothly, the process can wrap up in as little as 30–45 days. But with delays, back-and-forth requests, or external reviews, the whole thing may take up to 6 months.
Need Help?
At Lion’s Pride Insurance, we guide our clients through this process step-by-step. From submitting the appeal to figuring out who to call—we’re here to make it easier.
