If a health insurer denied your claim or prior authorization in New York, you have the right to appeal — and the deadlines and protections below are on your side. Here is exactly what applies in New York.
The first step is an internal appeal — a formal request asking your insurer to reverse its decision. In New York you generally have up to 180 days from the denial date to file it. A strong internal appeal cites your plan's own medical policy, the clinical evidence supporting your treatment, and the specific regulations the insurer must follow.
If the internal appeal is denied, you can escalate to an external review by an Independent Review Organization. New York uses , and the reviewer's decision is binding on the insurer. You typically have about 127 days to request it. If your situation is urgent, an expedited review must be completed within 72 hours.
New York provides protections beyond the federal minimum that can strengthen your appeal:
Note: Strongest consumer protections in the country
If your coverage is through a large employer that self-funds its plan, your appeal is governed by federal ERISA law rather than New York rules, and some state protections may not apply. Individual, marketplace, small-employer, and government plans are typically state-regulated. CareCost Appeals determines which framework applies from your plan details automatically.
CareCost Appeals generates a formal appeal letter tailored to your denial — citing real clinical evidence, your insurer's own medical policy, and the New York and federal rules above — in minutes.