What should I do if my ACA claim is denied?

You should carefully review the denial notice from your insurance company. The notice will explain the reason for the denial and provide instructions on how to file an appeal.

How long do I have to file an appeal?

Most insurance plans allow policyholders up to 180 days from the date of the denial notice to submit an internal appeal.

What is an external review?

An external review is an independent evaluation of a denied claim conducted by a third party that is not associated with the insurance company.

Can a doctor help with the appeal process?

Yes. Healthcare providers can submit medical records and supporting documentation to help strengthen your appeal.

Are insurance companies required to follow external review decisions?

Yes. If the external review overturns the denial, the insurance company must comply with the decision.

Guide

How to Appeal a Denied Health Insurance Claim Under ACA Plans

ENROLL HEALTHApr 7, 20263 min read

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