How many days do I have to appeal a health insurance denial in Florida?

Use the free tool — Health Plan Denial Appeal

The short answer

If you have an employer plan or an ACA marketplace plan in Florida, you generally have 180 days to file an internal appeal with your insurance company. If the internal appeal doesn't go your way, you generally have 4 months to ask for an external review by an independent reviewer. Both deadlines are counted from the date on your denial letter — not from the date you opened the mail or noticed the bill.

Where these numbers come from

The Affordable Care Act (45 CFR 147.136) sets internal and external appeal rights for ACA marketplace and many employer plans.
ERISA claims rules (29 CFR 2560.503-1) set appeal procedures for many employer-sponsored plans.
Florida Statutes 627.6472 and 627.602 add state-level appeal protections.

This is general information, not legal advice. Your specific plan document controls the exact deadline that applies to you — confirm the exact dates in your own letter and with your plan.

How the clock actually works

The 180 days for the internal appeal starts on the date printed on your denial letter.
The 4 months for external review starts after the internal appeal decision, again counted from the relevant letter date.
If your letter doesn't clearly show a date, or if something seems off about the timeline, ask your plan directly and don't assume — a missed deadline can cost you your right to appeal.

What to do before time runs out

Read the denial for the real reason: medical necessity, prior authorization, out-of-network, coding, or "experimental."
Request the clinical criteria the plan used, the reviewer's credentials, and the guideline applied — the plan must give you certain documents free of charge.
Ask your doctor to put the medical-necessity rationale in writing so it can support your appeal.
Send your internal appeal well before day 180, and your external review request well before the 4-month mark, so you have time to fix any problems.

If you have Medicare instead

This guide covers commercial plans only — employer plans, ACA marketplace plans, and individual health plans. Medicare, Medicare Advantage, and Medicaid fee-for-service have their own separate appeal systems and deadlines. If your denial is from Medicare, use Medicare Decoder instead.

Where to get free help

Florida Division of Consumer Services: 1-877-693-5236
For employer plans, U.S. DOL EBSA: 1-866-444-3272

This is not legal or medical advice. Always confirm your exact deadlines and rights with your plan or with one of these agencies.

What to do next

Paste your denial or explanation of benefits into the free tool. It reads your own letter and numbers — the actual date, reason code, and service — and tells you the real reason for the denial, computes your specific 180-day and 4-month deadlines, lists what to request from the plan, and drafts an appeal letter your doctor can sign.

Use the free tool

Health Plan Denial Appeal is an informational tool for commercial (employer, ACA marketplace, individual) health plan denials, based on the ACA (45 CFR 147.136), ERISA claims rules (29 CFR 2560.503-1) and Florida Statutes 627.6472 / 627.602 as of 2025–26. It does not cover Medicare, Medicare Advantage or Medicaid fee-for-service, which have their own appeal systems. It is not legal or medical advice and does not file appeals. It is not affiliated with any insurer, employer or agency.