Last updated: July 7, 2026
How Long Does Your Insurance Have to Respond to an Appeal?
Your insurer has legally mandated deadlines for responding to your appeal. Here are the exact timelines by claim type, with sources.
Standard Claims
Under the Affordable Care Act and federal ERISA regulations (29 CFR 2560.503-1):
- Pre-service claims (services not yet received): 30 days
- Post-service claims (services already received): 60 days
Urgent / Expedited Claims
For urgent claims — where a standard timeline could seriously jeopardize your life, health, or ability to regain maximum function — insurers must respond within 72 hours.
Your treating physician can request an expedited appeal on your behalf. If you're facing an urgent denial, see our step-by-step guide for denied prior authorizations.
Prior Authorization Specifically (2026 Update)
The CMS Interoperability and Prior Authorization Final Rule, taking effect in 2026, establishes new response requirements for prior authorization:
- Standard requests: 7 calendar days
- Urgent requests: 72 hours
Medicare Advantage Timelines
Medicare Advantage plans have their own appeal timelines, established in the CMS Medicare appeals and grievances process:
- Standard organization determination: 30 calendar days (with possible 14-day extension)
- Expedited organization determination: 72 hours
- Level 1 reconsideration: 30 calendar days standard, 72 hours expedited
Medicaid Timelines
Medicaid appeal timelines vary by state. There is no single universal federal timeline for Medicaid managed care appeals. Generally:
- Standard appeals are typically resolved within 30–45 days
- Expedited appeals are typically resolved within 72 hours to 3 business days
Check your state's Medicaid agency for specific timelines that apply to your plan.
What Happens If They Miss the Deadline?
If your insurer fails to respond within the legally required timeframe, this failure can have real consequences:
- You may become automatically eligible for external review, bypassing the internal appeal process entirely
- You can file a complaint with your state insurance department
- In some states, a missed deadline may be treated as a denial, triggering your right to the next level of appeal
Understanding your appeal letter structure and medical necessity denials can help you prepare while tracking deadlines.
We Track Your Deadline For You
ApproveIt automatically identifies your appeal deadline from your denial letter and monitors it throughout the process. If your insurer is approaching or has missed a deadline, we alert you so you can take the appropriate next step.