Insurance Advocacy
A denial is the start of a conversation, not the end of one.
Most denials are overturned when someone appeals — and most people never do. These guides show you the deadlines, the words, and the escalation path.
Prior authorization
Approval before the service. Delay is the most common failure mode.
Standard decisions are commonly 7–15 days; expedited urgent decisions are typically 72 hours.Open the guideUnderstanding denials
Read the reason code — it determines which argument wins.
Open the guideInternal appeals
Your first formal challenge, with strict deadlines.
Pre-service: 30 days. Post-service: 60 days. Urgent: 72 hours.Open the guideExternal review
An independent reviewer outside the insurer makes a binding decision.
Standard external review: about 45 days. Expedited: as fast as 72 hours.Open the guideMedicare
Five appeal levels, each with its own deadline.
Open the guideMedicaid
State-administered, with fair hearing rights.
Open the guideMarketplace plans
ACA plans carry full internal and external appeal rights.
Open the guideEmployer coverage
Most large employer plans are self-funded and governed by federal ERISA rules.
Open the guideEducational purposes only
Phoenix Health Compass does not provide legal advice or medical advice. This content summarizes publicly available government and nonprofit resources and is cited throughout. Always confirm requirements, deadlines, and forms with the official agency.
Last reviewed by the Phoenix Health Compass editorial team.