The internal appeals process should take a maximum of 30 days if you have not yet received the requested service or treatment and a maximum of 60 days if you have received the service or treatment but are waiting for reimbursement.[3]

You can skip the internal appeals process and request an external review in urgent situations.[4] Your situation is urgent if waiting 30 to 60 days would seriously jeopardize your life or your ability to regain function.

To request an expedited external review, call the U.S. Department of Health and Human Services at (888) 866-6205 or by complete an external review request form, which can be found here. You can submit the completed form by faxing it to (888) 866-6190) or by mailing it to:

MAXIMUS Federal Services
3750 Monroe Avenue, Suite 705
Pittsford, NY 14534.[5]