How Long Do You Have to Appeal an Insurance Denial? (2026 Deadlines)
The short answer: if you have an employer-sponsored or ACA plan, you usually have 180 days from the denial notice. If you have Medicare Advantage or Part D, you have 60 days from the date of the notice. The single most common reason appeals fail is not the argument — it's the deadline. This guide gives you the exact windows by plan type, how the clock starts, and what to do if you're already close to the edge.
Appeal deadlines by plan type
| Plan type | Internal appeal window | Clock starts |
|---|---|---|
| Employer-sponsored (ERISA) | At least 180 days | When you receive the denial ("adverse benefit determination") |
| ACA / Marketplace plans | At least 180 days | When you receive the denial |
| Medicare Advantage (Part C) | 60 days | Date of the plan's notice (organization determination) |
| Medicare Part D (drug coverage) | 60 days | Date of the coverage determination notice |
| Traditional Medicare (Part A/B) | Different, shorter window | Check your notice — never assume 180 |
Sources: Appeal Healthcare — ERISA/ACA deadlines · HHS OMHA — Medicare Advantage Level 1 appeals (60 days) · NAIC — how to appeal a denied claim (180 days)
Why these two numbers matter for GLP-1 denials
Most GLP-1 coverage (Ozempic, Wegovy, Zepbound, Mounjaro) runs through an employer plan or an ACA Marketplace plan — so the 180-day window usually applies. But a growing number of people get coverage through Medicare Part D (for approved indications) or Medicare Advantage plans that include drug coverage. If you fall into the Medicare bucket, your window is 60 days — three times shorter. Read your notice before you assume you have six months.
Calculate your exact deadline
Enter the date on your denial letter and your plan type. We count the days for you and flag how urgent it is.
How the clock starts (and why people lose days)
- ERISA / employer plans: the 180 days start when you receive the denial — not when it was mailed. Keep the envelope.
- Medicare: the 60 days run from the date of the notice, so mail time counts against you.
- Paperwork errors reset nothing. If you appeal late but can show the notice date was wrong or you never received it, request a written extension — some plans grant one with a good reason.
- External review has its own clock. After an internal denial, most states and federal rules give you a separate window (often 4 months) to request an independent external review — that's a second chance, not the same deadline.
What to do if you already missed the deadline
- Request an extension in writing — explain why it's late (lost notice, mail delay, illness) and ask for the plan's extension form.
- Ask about external / independent review — your state insurance department or the federal external review program may still accept a late request in limited cases.
- Re-file a new claim — if the denial was for a prior-authorization, a new prescription with updated documentation sometimes restarts the clock.
None of these are guaranteed — the only reliable move is filing inside the window.
Your deadline is the top of the funnel
Once you know how much time you have, the next question is what to actually write. Our 7-question appeal letter generator builds a medical-necessity letter from your denial reason in about a minute — free for the first look, then one-time $19. Related guides for specific drugs: Ozempic, Zepbound, Mounjaro, Wegovy, and the GLP-1 first-steps playbook.
Know your deadline? Write your appeal letter now — 7 questions, about a minute.
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