How to appeal a denial from a job-based or Marketplace health plan in Illinois
Deadlines and steps to appeal a health insurance denial from an employer or Marketplace plan in Illinois: internal appeal, then external review.
Deadline for the internal appeal
You must file the internal appeal within 180 days (6 months) of receiving the denial notice. Some employer plans require two levels of internal appeal before external review.
Source: HealthCare.gov, Internal appeals, checked 2026-10-17
How long the insurer has to decide
Generally 30 days for a service you have not received yet and 60 days for a service you already received. Urgent cases are decided much faster.
Source: CMS, Your right to appeal, checked 2026-10-17
External review in Illinois
For plans regulated by Illinois, you can ask the Illinois Department of Insurance for an independent external review within 4 months of receiving the final denial. If your health is at risk, you can ask for an expedited review at the same time as the internal appeal.
Source: Illinois Department of Insurance, How and when to file an external review, checked 2026-10-17
Self-funded employer plans
Many large employers pay claims themselves (self-funded plans). These follow federal rules, and the external review goes through the federal process instead of the state. The plan document or the denial letter says which applies.
Source: CMS, Internal claims and appeals and external review overview, checked 2026-10-17