Internal appeal
Updated September 30, 2026
Definition
Asking your health plan to take a second look at its decision to deny or not fully pay for care. You usually have 180 days from the denial notice to file.
An internal appeal is your request for your health plan to review its own decision. You might file one when your plan denies a claim, pays less than you expected, or won't approve care ahead of time.
You'll learn about the denial from a letter or your explanation of benefits (EOB). You generally must file within 180 days of getting that notice. Your plan must decide within 30 days for care you haven't gotten yet, and within 60 days for care you've already had.
If your plan still says no, you can usually ask for an external review by someone outside the plan. If you have Medicare, it has its own appeal steps. Start with our guide on how to appeal a health insurance denial.
Related terms
Guides that use this term
- Start hereHow to appeal a health insurance denialA denied claim isn't the final word. Learn how to appeal an insurance denial, from internal appeal to external review, with deadlines for each plan type.
- GuideInsurance didn't pay my medical bill: what to do nextInsurance didn't pay your medical bill? Find out why, match the denial code to the fix, and learn when to ask for a rebill and when to file an appeal.
- GuideDenial codes on your EOB, explainedWhat do CO-45, PR-1, and CO-16 mean? Look up common claim denial codes, learn who's responsible for each amount, and see what to do about each one.
Sources
- Internal appeals, HealthCare.gov. Accessed September 30, 2026.
- Appeal (glossary), HealthCare.gov. Accessed September 30, 2026.
- Filing an appeal (Medicare), Medicare.gov. Accessed September 30, 2026.
This is general information, not legal or medical advice. Rules can depend on your plan and your state. Romi Care isn't an insurer, law firm, collection agency, or government program.