How to appeal an FEHB plan denial
The short answer
If you are covered by the Federal Employees Health Benefits Program, you have 6 months from the date of the denial notice to ask your plan to reconsider. If the plan keeps its denial, you can ask the Office of Personnel Management (OPM) to review it within 90 days.
Deadlines, decision times and your rights
These are the limits in the federal rules. Your plan can give you more time but not less. If your denial letter prints an earlier date, go by the earlier one.
Deadline to appeal
6 months from the date of the denial notice
Rule: 5 CFR 890.105(b)(1)
What the rule says
The covered individual has 6 months from the date of the notice to the covered individual that a claim (or a portion of a claim) was denied by the carrier in which to submit a written request for reconsideration to the carrier.
How long they have to decide
30 days after the plan receives your request
Rule: 5 CFR 890.105(b)(2)
What the rule says
The carrier has 30 days after the date of receipt of a timely-filed request for reconsideration to: (i) Affirm the denial in writing to the covered individual; (ii) Pay the bill or provide the service; or
90 days after OPM receives your request: a decision or a status notice
Rule: 5 CFR 890.105(e)(4)
What the rule says
Within 90 days after receipt of the request for review, OPM will either: (i) Give a written notice of its decision to the covered individual and the carrier; or (ii) Notify the individual of the status of the review.
The next level
90 days from the date of the plan's notice upholding the denial
Rule: 5 CFR 890.105(e)(1)
What the rule says
Such a request to OPM must be made: (i) Within 90 days after the date of the carrier's notice to the covered individual that the denial was affirmed;
120 days after the date you sent your timely reconsideration request, if the plan never responded
Rule: 5 CFR 890.105(e)(1)(ii)
What the rule says
If the carrier fails to respond to the covered individual as provided in paragraph (b)(2) of this section, within 120 days after the date of the covered individual's timely request for reconsideration by the carrier; or
Each rule links to its text in the Electronic Code of Federal Regulations. Checked against the regulation text on November 10, 2026. The Lamdis app works out your dates from these same rules.
Step 1: ask your plan to reconsider
Write to your plan within 6 months from the date of the notice that your claim was denied (5 CFR 890.105(b)(1)). The plan then has 30 days to pay, approve, or put its denial in writing, or to ask you or your provider for more information (5 CFR 890.105(b)(2)).
If something outside your control kept you from filing in time, the time limit can be extended.
Step 2: ask OPM to review
If the plan affirms its denial, you can ask OPM to review it. The request must be made within 90 days after the date of the plan’s notice affirming the denial (5 CFR 890.105(e)(1)(i)). Include a copy of the denial and the documents that support your claim.
What the plan’s letter must tell you
When the plan keeps its denial, its letter must give the specific reasons, tell you about your right to ask OPM for review, and explain that OPM must receive your request within 90 days (5 CFR 890.105(d)). Keep that letter: you will send a copy to OPM.
Questions people ask
How long do I have to appeal an FEHB denial?
6 months from the date of the denial notice (5 CFR 890.105(b)(1)).
What do I send to OPM?
A request for review made within 90 days of the plan’s letter affirming the denial, with a copy of that letter and the documents that support your claim (5 CFR 890.105).
Sources
- eCFR: 5 CFR 890.105, Filing claims for payment or service
The covered individual has 6 months from the date of the notice to the covered individual that a claim (or a portion of a claim) was denied by the carrier
This page is general information about appeal rules in the United States. It is not legal or medical advice. Rules can change, and your plan’s documents and your denial letter control the dates that apply to you.