A denied claim has a next step
Gather the right information before you appeal a commercial health plan’s decision.
Read the reason
Find the denial reason, appeal instructions and deadline on the notice. Ask whether a corrected claim or missing information could resolve the issue.
Build a clear record
Keep the EOB, denial, relevant clinician information and a dated contact log. Follow the plan’s submission instructions and retain proof of delivery.
Escalate through the right channel
HealthCare.gov describes a 180-day internal appeal window for applicable plans. External review may follow. Urgent cases can have different procedures; consult the notice and your plan.
Medicare and Medicaid use different pathways. Never assume this commercial-plan timeline applies to them. Current external-review extensions may also apply; check the linked source.
Checked against the linked sources in September 2026. Not yet reviewed by a named clinician or billing professional; that review is planned and will be shown here when complete.
Build a next-step checklist