DenialFax · Q&A

I faxed my appeal weeks ago and got no response. Now what?

By Aman, Founder, Apellica. Last reviewed 2026-05-22.

Federal regulation gives carriers a fixed window to respond to internal appeals. For ACA-regulated plans, the response deadline is 30 days for pre-service appeals and 60 days for post-service appeals (45 CFR 147.136). For ERISA plans, the windows are similar under 29 CFR 2560.503-1. Carriers who blow these deadlines have, by definition, failed the appeals process, and the regulations give you remedies.

First, calculate the actual deadline. Start from the date the carrier received your fax (your transmission receipt timestamp). For most pre-service appeals (the care has not happened yet, often a medication or upcoming procedure), the carrier has 30 days under federal regs. For post-service appeals (the bill is already in dispute), the carrier has 60 days. If those days have elapsed and you have heard nothing, the appeal process is procedurally broken.

Second, send a status request in writing. Fax it to the same appeals number. Include your original transmission receipt, the appeal cover sheet, and a single paragraph: 'Status request: appeal filed on [date] for [member], [member ID]. No response received as of [today]. The carrier is now [X] days past the [30 or 60]-day response window required by 45 CFR 147.136 / 29 CFR 2560.503-1. Please confirm receipt and disposition within 5 business days.' This creates a documented trail.

Third, file a state Department of Insurance complaint. Every state has a consumer-complaint mechanism through the state DOI, and many states (California DMHC, Texas TDI, New York DFS, Florida OIR) maintain online complaint portals. The complaint is short: who, what, when, what is the failure. The DOI sends the carrier a formal request for response, which typically triggers a written carrier reply within 10 to 15 business days. That reply often resolves the underlying claim, because the carrier would rather refund the disputed claim than respond to the DOI with a paper trail of an ignored appeal.

Fourth, if the plan is ERISA-governed (self-funded employer plans, including most large-employer plans), invoke 29 CFR 2560.503-1(l). That paragraph says that if the carrier fails to follow the appeals procedures the regulation requires, the appeal is deemed exhausted and the member can proceed directly to external review or federal court. A deemed-exhaustion notice is a one-paragraph letter you fax to the carrier and a copy of which you send to the external-review entity. Deemed exhaustion is a substantial lever and few DIY appellants know it exists.

Fifth, do not let the external-review window close while the internal appeal is unresolved. Most states give 4 months after exhaustion (or deemed exhaustion) to file the external review. Calendar that date the moment your internal appeal goes unanswered.