My appeal was denied. What now?
A second no from the insurance company is not the final word. There is usually one more door, and the clock on it matters, so start with your letter.
CheckMyDenial team, patient billing and appeals. Published October 2026. Last reviewed 2026-10-29.
My appeal was denied. Is it over?
Often, no. You are not alone, and a final denial from your insurance company is frequently just the end of the company's own review. Healthcare.gov explains that if your insurer still denies your claim after an internal appeal, you can file for an external review.
Look at the letter you just got. The insurer's final decision has to tell you how to ask for an external review, so that letter is your map. Keep it, and keep every earlier letter too.
What is an external review and who decides?
An external review means someone outside your insurance company takes a fresh look. On healthcare.gov, the external reviewer issues a final decision that either upholds the insurer's decision or rules in your favor.
Healthcare.gov says your insurer is required by law to accept the external reviewer's decision. External review covers denials that involve medical judgment, such as care the plan calls not medically necessary, and denials of treatment the plan calls experimental or investigational. You can file yourself, or name a representative, such as your doctor, to file for you.
How long do I have to ask for an external review?
Healthcare.gov says you generally have 4 months from the date you receive the insurer's notice or final determination. Your letter should state the exact deadline for your plan, so go by the letter. Do not wait. Write the date you received the letter on the first page and count forward from it.
Once you ask, a standard external review is decided no later than 45 days after the request is received. If waiting could seriously harm your health, you can ask for an expedited review, which is decided no later than 72 hours, or sooner, depending on how urgent the case is.
What are the steps after a denied appeal?
Here is a simple order to follow. Your plan type may change the details, so check your denial letter.
- Step 1: Find the date and the deadline. Write down the date you received your final denial letter and check the letter for its deadline. For many private plans that is 4 months, so mark it on a calendar.
- Step 2: Find out what kind of plan you have. Ask your employer's benefits office or the insurer whether the plan is fully insured or self-funded, or whether it is Medicare or Medicaid. This decides which rules apply and who oversees a complaint.
- Step 3: Ask for external review or the next appeal level. Follow the steps in your final denial letter. Ask your doctor for a short letter saying why the care is needed, and send it with your request.
- Step 4: Add a state complaint or call for help. If your plan is regulated by your state, file a complaint with your state insurance department. If it is an employer self-funded plan, ask your employer's HR or benefits office, and consider a patient advocate.
Can I complain to my state insurance department?
Yes, if your plan is one your state regulates. The NAIC, the national group of state insurance regulators, runs a page where you pick your state and find your insurance department so you can file a complaint about a problem with an insurance company.
A complaint does not replace your appeal deadlines, so do both at the same time if you can.
My insurance comes from my employer. Does anything change?
It can. Many employers pay claims themselves, which is called a self-funded or self-insured plan. KFF explains that states cannot regulate self-insured group health plans, so state external appeal laws have not applied to them, and federal appeal rights apply instead.
That means your state insurance department may not be the right place. Ask your HR or benefits office who runs the plan, and read your plan document, called the Summary Plan Description, for its outside review steps. Your denial letter should describe them as well.
I have Medicare or Medicaid. Is it the same?
No, these follow their own appeal rules. Medicare.gov says there are generally 5 levels of appeal, and at each level you get a decision letter with instructions on how to move to the next level. The process differs between Original Medicare and Medicare plans, and a plan must tell you in writing how to appeal.
If you have Medicaid, the steps are set differently too, so follow the instructions in the notice you received and keep its deadline.
When does a patient advocate help?
A patient advocate can help when the paperwork feels like too much, when the case is complicated, or when you are worn out. They can help you gather records, track deadlines and write the request.
Many hospitals have patient advocates, and some nonprofits offer help. Ask about fees before you agree to anything. You can also text a photo of your denial letter to (213) 606-6303. We read it and reply with where it breaks, free, no account, no form.
Your checklist
- Write the date you received your final denial letter at the top
- Find the deadline in the letter and mark it on a calendar
- Find out if your plan is self-funded, insured, Medicare or Medicaid
- Ask your doctor for a short letter on why the care is needed
- Request external review or the next appeal level using the steps in your letter
- File a state insurance department complaint if your plan is state regulated
- Keep copies of every letter, call date and name
Which rules apply to you?
The steps and deadlines on this page can differ by the kind of plan you have. Your own denial letter always comes first.
- Coverage through a job:ask your HR team whether the plan is “self-funded” or “fully insured.” It can change who you can ask for help. Most private-sector job plans fall under a federal law called ERISA, and the U.S. Department of Labor’s EBSA takes health plan questions at Ask EBSA or 1-866-444-3272.
- Marketplace plan: follow the appeal steps at HealthCare.gov.
- Medicare or Medicaid: each has its own appeal process, listed on your notice.
- Dental-only plan: your plan contract sets the appeal rights, so read it and your letter.
Related answers
Sources: HealthCare.gov: External review. HealthCare.gov: Internal appeals. Medicare.gov: Filing an appeal. NAIC: State insurance departments and complaints. KFF: Consumer appeal rights in private health coverage. More in the full appeal guide.
Start here
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Free tools for the next step
Keep your appeal papers in one place. Take a photo of your denial letter, EOBs and insurance cards with GetPreCare, so they are on your phone when the insurer or the office asks. Free. Open GetPreCare. Helping a parent or partner? Set it up for them.