Florida health insurance appeal rights
Denied in Florida? You have a two-step path: an internal appeal to your plan, then a free federal external review administered by HHS. Here’s how it works, who runs it, and the four-month deadline to watch.
How appeals work in Florida
Florida gives you a two-step path after a denial. First you appeal to your health plan (the internal appeal). If the plan still says no, you can request an external review — an independent look by reviewers outside your insurer. Florida uses the federal external review process administered by the U.S. Department of Health and Human Services (HHS), run by its contractor MAXIMUS Federal Services, rather than a state-run program. The external reviewer’s decision is binding on your plan.
External review generally applies when a plan denies care as not medically necessary, experimental or investigational, or rescinds coverage. Self-funded employer plans follow the same federal external review path.
Step 1 — your internal appeal
Appeal to your plan in writing first, with the denial notice and supporting records. Federal rules generally give you at least 180 days from the denial to file — confirm the deadline on your own notice. For urgent situations you can ask for an expedited appeal, and you may request an external review at the same time.
Step 2 — the federal external review
After your final internal denial, request an external review from the HHS-administered process. It is free to you. A standard decision comes no later than 45 days after a complete request; an expedited review for urgent situations is decided within 72 hours. A recent Florida law (effective October 2024) broadened what counts as “urgent,” widening access to the faster track.
You generally must request the external review within four months of your final internal denial. Calendar it as soon as your denial arrives.
Where to file and get help
- Federal external review — MAXIMUS Federal Services: 1-888-866-6205. See the HealthCare.gov external-review guide.
- Florida Department of Financial Services — consumer helpline 1-877-693-5236 for insurance complaints and help.
Putting it together
Read the denial, file your internal appeal, then request the federal external review if you’re turned down. Our step-by-step guide covers each stage, external review explains how independent review works, and the appeal-deadline guide helps you track your dates. In another state? See Texas or New York appeal rights.
Frequently asked questions
How long do I have to request an external review in Florida?
Generally four months from the date of your final internal denial. Check the deadline on your own denial letter and act promptly.
Who runs external review in Florida?
Florida uses the federal external review process administered by the U.S. Department of Health and Human Services (HHS), run by its contractor MAXIMUS Federal Services — not a state-run program. The reviewer’s decision is binding on your plan.
Does it cost anything?
No. The external review is free to you.
How fast is a decision?
A standard external review is decided no later than 45 days after a complete request; an expedited (urgent) review is decided within 72 hours.
Denied in Florida? Build your appeal free
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IntelClaim is a self-help tool — not legal, medical, or insurance advice — and does not guarantee any particular outcome. Information on this site is general and may not reflect the rules of your specific plan or state. Always read your own denial letter, plan documents, and the deadlines that apply to you, and consider professional advice for your situation. No PHI is collected on this marketing site.