Internal Appeal

An internal appeal is your request for the plan itself to reconsider a denial, and it is usually the required first step before an outside review. Commercial and employer plans commonly give you at least 180 days from the denial to file, but public programs can be much shorter. Medicare Advantage and Part D give you 60 days from when you received the notice (42 CFR 422.582(b) / 423.582(b)), and Medicare treats you as having received it five days after the date printed on it, so counting from that printed date you have about 65 days. Medicaid managed care gives you 60 calendar days from the date on the notice (42 CFR 438.402(c)(2)(ii)); to keep benefits going while you appeal you have to act sooner. Always check the deadline printed on your denial letter. Completing the internal appeal, even when you expect it to fail, is often necessary to unlock your right to external review.