How to appeal a health-insurance denial in Georgia. The federal rights below apply to most plans here; Georgia's insurance regulator runs the external-review step.
The exact deadlines are in your denial letter and they control. Bursify tracks them for you.
Under the Affordable Care Act, you can ask your health plan to reconsider a denial. You generally have up to 180 days from the denial notice to file. Your plan must give you a full, fair review by someone who was not involved in the original decision.
If the internal appeal is denied, you can request an external review by an Independent Review Organization (IRO), a neutral medical reviewer outside your plan. The request deadline is generally up to four months after the final internal denial, and the IRO’s decision is binding on the plan.
If waiting would seriously jeopardize your health, you can request an expedited appeal, and the internal and external reviews can run at the same time. Urgent decisions are made on a much shorter timeline.
The federal No Surprises Act protects you from most surprise balance bills for emergency care and for out-of-network care at an in-network facility. Disputes over those amounts run through a separate federal process, not the standard appeal.
If your coverage is an employer self-funded plan, federal ERISA rules govern your appeal deadlines and procedures, and state external review may not apply, but the federal external review process still does. Your denial letter must state the reason for the denial and your appeal rights and deadlines; those deadlines control.
Georgia's external review is administered or overseen by the Georgia Office of Commissioner of Insurance and Safety Fire through its Consumer external review. After your plan's final internal denial, you can ask for an independent review; confirm your specific deadline and how to file from your denial letter and the regulator.
When you appeal a denial with Bursify, we read the denial letter, draft the internal-appeal letter citing the rights that apply to your plan, and track every deadline through external review. You review and sign as the filer of record, we never decide your claim, and we never represent you as an agent or adjuster.
This page is general information, not legal or insurance advice, and does not create an attorney-client or agent-client relationship. Appeal deadlines and procedures vary by plan and change over time, the controlling deadlines are in your denial letter. For advice about your situation, contact your plan, your state insurance regulator, or a licensed professional.