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Your Situation
Tell us about the insurance denial so we can route your appeal correctly under federal and state law.
This determines which state insurance protections and external review processes apply to your appeal.
Self-funded plans are governed by ERISA (federal law only — state insurance mandates do NOT apply). Fully insured employer plans are subject to ERISA + ACA + state law. Marketplace/individual plans get full ACA + state protections. Check your Summary Plan Description or call HR to find out.
Most denials start with a first internal appeal. ERISA plans must provide at least one level of internal appeal. The ACA requires one internal appeal before external review. If your situation is urgent (ongoing treatment, serious condition), you may request expedited review.
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