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72-Hour Urgent ERISA Appeal Process
When waiting for the standard timeline would harm your health, federal law lets you expedite. This is the step-by-step process for an urgent (expedited) ERISA appeal.
Written for providers, billers, and patients.
An expedited appeal is the urgent track inside the standard ERISA appeal process. Instead of waiting weeks for each level, you can get a binding decision in 72 hours, and you can file internal and external review at the same time.
The trade-off: you must qualify as urgent and you must move quickly. The five steps below walk through exactly how, with the documentation and legal citations the plan has to honor.
The 72-hour window
The plan must decide within 72 hours of receiving your expedited appeal.
That is 72 calendar hours: weekends and holidays count toward the clock.
- Plan must decide within
- 72 hours of receipt
- Written confirmation within
- 48 hours of a verbal decision
- IRO must decide within
- 72 hours of receiving the case
- 72 hours means
- calendar hours · weekends and holidays count
First, do you qualify?
What qualifies as urgent?
A claim is urgent if waiting for the standard timeline would do any of the following:
- Seriously jeopardize your life or health
- Jeopardize your ability to regain maximum function
- Subject you to severe pain that cannot be adequately managed without the requested treatment
Your physician decides urgency
The process
The expedited appeal, step by step
Move through these in order, but file Steps 2 and 3 together: filing internal and external review simultaneously is the advantage that urgent cases get.
- 1
Get physician urgency certification (required)
A Physician Urgency Certification is a letter from your treating doctor stating that your medical situation qualifies as urgent under federal law. Without it, you are stuck with standard timelines (30 to 60 days instead of 72 hours).How to obtain it
- Call your treating physician’s office and request a "Physician Urgency Certification Letter for ERISA Appeal".
- The letter must state that waiting for standard timelines would seriously jeopardize your life or health, OR jeopardize your ability to regain maximum function, OR cause severe unmanageable pain.
- The letter must cite 29 CFR 2560.503-1(m)(1). Tell your doctor to include this.
- Get this immediately. Most doctors can write it same-day if your case qualifies.
Why this matters: the physician urgency determination is legally binding on the insurance plan. They cannot override your doctor’s clinical judgment.
- 2
File expedited internal appeal
How to file
- Call the insurance company’s appeals line (fastest, and they must accept phone calls for urgent cases).
- Or fax your appeal.
- Or submit via their online portal.
Include
- Patient identifying information.
- Copy of the denial letter you are appealing.
- Physician urgency certification letter.
- All supporting medical records and clinical documentation.
- Clinical practice guidelines supporting medical necessity.
- 3
File expedited external review (simultaneously)
In normal (non-urgent) appeals, you must wait for the insurance company to deny your internal appeal before you can request external review. For urgent cases, federal law lets you file both at the same time. You do not have to wait, which speeds up the process by weeks.How to file
- Submit to the insurance company (they forward to the Independent Review Organization).
- Mark it "EXPEDITED EXTERNAL REVIEW REQUESTED - FILING SIMULTANEOUSLY WITH INTERNAL APPEAL".
- Include the same documentation as Step 2.
- No filing fees. External review is free.
Legal authority: 29 CFR 2590.715-2719(d)(3)(i)(A) and (c)(2)(iii).
- 4
Insurance company decides in 72 hours
Timeline
- The clock starts when they receive your expedited appeal.
- They must decide within 72 hours.
- If they give a verbal decision, written confirmation must follow within 48 hours.
Continued coverage: for ongoing treatment, the plan must continue coverage while your appeal is pending.
- 5
If denied internally, IRO decides in 72 hours
What happens
- An independent medical expert (IRO) reviews your case.
- The IRO must decide within 72 hours of receiving the case.
- The decision is binding on the insurance company.
- The IRO reviews de novo (from scratch), and is not bound by the insurance company’s decision.
Mark every submission clearly
Step 5 reference
Federal external review contact
When a plan uses the federal external review process, MAXIMUS Federal Services is the Independent Review Organization that handles it. Use these channels to submit a request or check status.
MAXIMUS Federal Services
- Request form: 1-888-866-6205
- Status line: 1-888-975-1080
- Fax: 1-888-866-6190
- Mail: MAXIMUS Federal Services, 3750 Monroe Avenue, Suite 705, Pittsford, NY 14534
Critical reminders
- Physician certification is required. Without it, you are back to standard timelines (30 to 60 days).
- File internal AND external simultaneously. This is your unique advantage in urgent cases.
- 72 hours means calendar hours. Weekends and holidays count.
- Document everything. Get confirmation numbers for all submissions.
- Plans must continue coverage during urgent appeals for ongoing treatment.
Keep reading
Related guides
ERISA Appeals Resource Guide
The full 3-level process for employer-sponsored plans.
ReadACA / Marketplace appeals
For individual marketplace plans, which are not ERISA.
ReadNo Surprises Act appeals
Protections for surprise out-of-network bills.
ReadAppeal tips and FAQ
Common questions and practical tactics that win appeals.
ReadAppeal deadlines
Every filing window, in one reference.
ReadAppeals glossary
Plain-English definitions of ERISA, IDR, QPA, SPD, and the rest.
ReadDisclaimer
This guide is for informational purposes only and does not constitute legal or medical advice. Appeal It Now provides administrative support and appeal preparation services only; we are not a law firm. Please consult a qualified professional for advice specific to your situation.
Version 1.0 · Updated May 2026