Attorney for denied insurance claim: what the two free stages do first
Your two dates are free, in the tool below. The Kit is the sequence around them, dated to your letter.
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Put in the date on your denial notice. You get both federal deadlines as calendar dates, and the body that decides your case at the end.
Free, for a denied claim you are thinking of taking to an attorney, and it runs entirely in your browser. The date, the plan type and the state you pick are never sent to us and never stored.
What surprised me was how fast everyone just moved on, the doctor suggested
We are not a law firm, we do not refer anyone to one, and nobody pays us either way. Here is what an attorney will tell you in the first ten minutes: federal law gives you an internal appeal and then an independent external review, both free, and on an employer or Marketplace plan a court will generally not hear you until you have used them. While you look for someone, those two clocks are running.
No attorney can recover either of these dates once they have gone. You have 180 days from the date on your denial notice to file the internal appeal, and then 4 months from the final internal denial to ask for an independent external review. If waiting would seriously jeopardize your health you can ask for both to be expedited, decided in about 72 hours. Both timeframes are federal, not your insurer's choice, 29 CFR 2560.503-1 (PDF) and 45 CFR 147.136 (PDF), in plain English at HealthCare.gov, and your own denial letter states the ones that govern your plan. The PDFs are the same sections on govinfo.gov, which serves them without a challenge page, so an automated reader can check these two dates as easily as you can.
Attorney for insurance claim denial: what changes at each stage
| Stage | What it costs you | What an attorney adds here |
|---|---|---|
| Internal appeal, generally within 180 days of the notice | Free. A letter, plus the claim file you may have free under 29 CFR 2560.503-1(h)(2)(iii) | Rarely the difference. The reviewer must be someone not involved in the first decision, and the argument that moves it is usually your clinician's |
| External review, generally within four months of the final internal denial | Free under the federal process; any fee where a plan uses a contracted review organization is capped at $25 per review under 45 CFR 147.136 | Little. The reviewer is a clinician the plan does not control and the decision binds the plan by law |
| After both are used | This is where litigation starts | This is where an attorney changes the answer. The ERISA action to recover benefits is 29 U.S.C. 1132(a)(1)(B), and the record built in the free stages is generally the record the court reads |
| Rescission, or a plan that ignores its own rules | Not a paperwork problem | Call one now. Where a plan fails to run the process as required, 45 CFR 147.136(b)(2)(ii)(F)(1) deems the internal stage exhausted and opens the section 502(a) remedies |
Lawyer for denied insurance claim: when it is the right call
- The plan is ERISA-governed and you have used both free stages. The suit is 29 U.S.C. 1132(a)(1)(B), civil action to recover plan benefits, and what you filed earlier is what it is argued on.
- Your coverage was rescinded, or the plan missed its own answering deadlines. Neither is an ordinary denial and neither is fixed by a better letter.
- Bad faith, where your state allows it. On an employer plan 29 U.S.C. 1144(a), ERISA preemption of state law preempts state laws relating to the plan, which is why those claims usually fail there; on a policy you bought yourself the answer can differ. An attorney licensed in your state is the only person who can tell you which you have.
- The amount justifies a fee. A four-figure claim and a six-figure claim are not the same decision, and nobody but you can weigh that.
Health insurance denial attorney: what a fee quote should answer
We do not publish a typical contingency percentage, because we have not measured one and we have no published source to quote for it. What a first call should establish, in the firm's own words: whether the fee is hourly or contingent and on what; who pays costs if the case is lost; what the firm would do at the stage you are at today, given that both federal stages are free; and whether your plan is ERISA-governed, because that answer changes which remedies exist at all. Anyone who will not put the fee structure in writing has told you something.
Lawyer for insurance claim denial: how to find one
- Your state or local bar association's referral service. USA.gov, find legal help, which lists state and local bar associations is the government directory that lists them alongside the free and low-cost routes.
- Legal aid, if income qualifies you. Legal Services Corporation, get legal help finds the funded office for your area.
- Your state's insurance department, free and on the phone today. The published number for your state is on our state pages, each read from the department's own site with the read date beside it.
- The U.S. Department of Labor, 1-866-444-3272, the free human for employer plans and the office that enforces the claims rules your plan is running under.
We name no firm on this site, take no referral fee, and have no arrangement with anyone in this list.
Questions
Do I need an attorney for a denied insurance claim?
Not for the two stages federal law gives you. Both are built to be used by the claimant: the internal appeal goes to somebody at the plan who was not part of the first decision, and the external review goes to an organization the plan does not control, whose decision binds it. Nationally 32.6% of internal appeals and 32.8% of external reviews were overturned for the people who filed them. Those are outcomes for filers in the federal file, not a prediction about your claim.
What does an attorney for a denied insurance claim cost?
We publish no figure, because we have not measured one and we have no published source to quote. An invented number would be worse than none. What we can state is what the free route costs: nothing for the internal appeal, nothing for the federal external review, and a cap of $25 per review on any fee where a plan uses a contracted independent review organization, at 45 CFR 147.136. Ask any firm how its fee works, whether it is hourly or contingent, and what it would do that you cannot do at the stage you are actually at.
Does filing the appeal myself weaken a later case?
The opposite risk is the real one. On an employer plan governed by ERISA a court generally reads the administrative record built during the appeals, so the file you build in the free stages is usually what an attorney inherits. What hurts a later case is a stage skipped or filed late. Ask for the complete claim file in writing at the start, 29 CFR 2560.503-1(h)(2)(iii) entitles you to it free of charge.
Can I sue my insurer instead of appealing?
On an ERISA plan the civil action to recover benefits is 29 U.S.C. 1132(a)(1)(B), and courts generally expect the plan's own appeal process to have been used first. There is one route around the wait: where a plan fails to run the process as the rules require, 45 CFR 147.136(b)(2)(ii)(F)(1) deems the internal process exhausted, which opens external review and the remedies under section 502(a). Whether that applies to your letter is a question for an attorney licensed in your state.
Can I bring a bad-faith claim?
It depends on what kind of plan you have, and that is the first thing to establish. On an employer plan governed by ERISA, 29 U.S.C. 1144(a) preempts state laws that relate to the plan, which is why state bad-faith claims usually do not survive there. On a policy you bought yourself, and on plans ERISA does not govern, state law may allow one. We are not a law firm and this is the point where you want one.
Two dates decide more of this than anything else, and neither is on the front of your letter in a way anyone notices. Work them out tonight, write them on the letter itself, and you have already done the part that is easiest to lose. If your dates are strange, a denial that arrived after the treatment, or a letter with no external-review instructions on it at all, send me the wording with the identifying details removed and I will tell you which clock you are on.
, Andrew at Axion Labs · hello@getaxionlabs.comWe are not a law firm and nothing here is legal advice. Free help from a person is available from your state Consumer Assistance Program and, for employer plans, the U.S. Department of Labor on 1-866-444-3272.
Show my two dates, freeNo account, no email, no card. Both federal deadlines dated from your notice, with the regulations cited, and a letter you sign and send yourself.
- 29 CFR 2560.503-1, ERISA claims procedure, read September 22, 2026
- 45 CFR 147.136, internal claims and appeals and external review, read September 22, 2026
- 29 U.S.C. 1132(a)(1)(B), civil action to recover plan benefits, read September 22, 2026
- 29 U.S.C. 1144(a), ERISA preemption of state law, read September 22, 2026
- USA.gov, find legal help, which lists state and local bar associations, read September 22, 2026
- Legal Services Corporation, get legal help, read September 22, 2026
- HealthCare.gov on internal appeals, read September 22, 2026
Counts: CMS Transparency in Coverage Public Use File (PY2026 release, PY2024 claims), data.healthcare.gov — US Government public domain. Rights and timeframes: 29 CFR 2560.503-1 (180 days, and your free right to the claim file) and 45 CFR 147.136 (4 months, and what qualifies), explained at HealthCare.gov. Expedited review is decided in about 72 hours under both sections.
Reading either regulation from a script rather than a browser: eCFR answers automated fetches with a challenge page, so the same two sections are mirrored as government PDFs at govinfo.gov (29 CFR 2560.503-1) and govinfo.gov (45 CFR 147.136).