How long an insurance appeal takes depends on what kind of insurance you have and how urgent the claim is. Health insurance appeals run on strict federal clocks: 72 hours for urgent care, 30 days for treatment you haven’t received yet, and 60 days for treatment already provided.1HealthCare.gov. Internal Appeals Auto and homeowners appeals have no uniform federal deadline and follow state law, where decisions commonly land somewhere between a few weeks and several months. If your health insurer upholds the denial, an independent external review adds up to 45 more days, or as little as 72 hours in an emergency.2HealthCare.gov. External Review
Health Insurance Appeal Timelines
Federal regulations set the maximum time your health insurer can take to decide an internal appeal. Those caps are the same across non-grandfathered marketplace and employer-sponsored plans:
- Urgent care appeals: 72 hours after the insurer receives your appeal.3Centers for Medicare & Medicaid Services. Appealing Health Plan Decisions
- Pre-service appeals (care you haven’t received yet): 30 days.3Centers for Medicare & Medicaid Services. Appealing Health Plan Decisions
- Post-service appeals (care already received): 60 days.3Centers for Medicare & Medicaid Services. Appealing Health Plan Decisions
Some employer plans run two internal appeal levels. When they do, each level gets a shorter window: 15 days per level for pre-service claims and 30 days per level for post-service claims, and the total across both rounds still shouldn’t exceed 60 days for post-service claims.4eCFR. 29 CFR 2560.503-1 – Claims Procedure For urgent care, the plan can let you skip internal review entirely and go straight to external review at the same time.3Centers for Medicare & Medicaid Services. Appealing Health Plan Decisions
You have 180 days from the date you receive the denial to file your internal appeal. Miss that window and the internal process closes, which also cuts off external review and, for employer plans, the ability to sue.
Adding External Review to the Timeline
If the insurer upholds its denial, you can ask for an external review by an independent review organization with no ties to your plan. Its decision is binding on the insurer.
You have four months from the final internal denial to request external review. The plan then has five business days to complete a preliminary eligibility check.5eCFR. 45 CFR 147.136 – Internal Claims and Appeals and External Review Processes From there, the reviewer has up to 45 days after receiving the case to issue a written decision.2HealthCare.gov. External Review
Expedited external review is available when the standard clock would seriously jeopardize your health, or when the denial involves an emergency admission or a continued hospital stay. In those cases the reviewer must decide within 72 hours.5eCFR. 45 CFR 147.136 – Internal Claims and Appeals and External Review Processes The federal external review process through HHS is free.6Centers for Medicare & Medicaid Services. HHS-Administered Federal External Review Process Some state-run programs charge a nominal filing fee, generally $25 or less.
Add the two stages together and a full health insurance appeal, from filing internally through an external decision, can run anywhere from three days for an urgent care case to roughly three months for routine post-service claims that go the full distance.
What Slows an Appeal Down
Those federal caps are ceilings, not promises. Several things routinely push appeals closer to the maximum, or past it.
Incomplete documentation is the most common cause. Missing medical records, a repair estimate, or a supporting letter from your doctor sends the insurer back to third parties for information, and each handoff adds days. Complex questions, like whether a treatment is experimental or how a policy exclusion applies, tend to get routed through multiple internal departments or outside consultants. If your plan has two internal levels, each one runs on its own clock.
Outside events matter too. Homeowners insurers hit with a wave of claims after a hurricane or wildfire slow down for everyone. Health plans get seasonal backlogs. None of that excuses missing a legal deadline, but it explains why appeals often creep toward the outer edge of what the rules allow.
When the Insurer Misses Its Deadline
If your insurer blows past the legal timeframe without a good explanation, you have real leverage. For health insurance, that failure can amount to what regulations call deemed exhaustion of internal appeals, meaning you can proceed directly to external review, or, for an ERISA plan, to court, without waiting any longer.
Before it comes to that, call the insurer and ask for a status update. Get the name of the person handling your file, confirm they have every document they need, and ask for a specific decision date. Keep a written log of every call: date, name, and what you were told. Insurers tend to locate their deadlines quickly once they realize you know the rule.
If direct pressure doesn’t work, file a complaint with your state insurance department. The department will forward the complaint to the insurer and require a formal response, and if state insurance laws were violated it can order corrective action. For health plans, the consumer assistance program or ombudsman listed on your denial notice is another route.7eCFR. 45 CFR 147.136 – Internal Claims and Appeals and External Review Processes For large ERISA claims, or when delays are causing real financial damage, an attorney is worth considering.
Auto and Homeowners Appeals Run on Different Clocks
The federal timelines above only govern health insurance. Auto and homeowners insurance appeals are set by state law, and the variation between states is significant.
Most states require the insurer to acknowledge a claim promptly, often within 15 days, and to affirm or deny coverage within a reasonable time after finishing its investigation. That investigation period commonly runs 30 to 45 days, longer for complex claims. If your dispute is over the amount of the loss rather than whether it’s covered, most homeowners policies and many auto policies include an appraisal clause: each side picks an appraiser, and an umpire breaks a tie. Appraisal can take a couple of months for a simple claim or well over a year for a large or complicated one. The result is usually binding on the amount, but it does not resolve coverage disputes.
For a straight coverage denial on an auto or home claim, your options after the insurer’s internal review typically include mediation, appraisal for valuation disputes, or a complaint to your state insurance department. There’s no guaranteed free external review the way there is with health insurance, so how long the process takes, and what it looks like, depends heavily on your state and your policy.