Texas health insurance appeal rights

Sarah Chen, RN-BSN, CPCSarah leads InsureDefense's clinical review. 12 years working appeals at a major US payer plus 4 years as a patient advocate.

Published May 14, 2026

Internal appeal in Texas

Under the ACA, you generally have 180 days from the date you receive the denial notice to file an internal appeal. The insurer must decide the appeal within 30 days for pre-service claims, 60 days for post-service claims, and 72 hours for expedited appeals where waiting could jeopardize your health.

The Texas Department of Insurance oversees consumer protections for Texas health-insurance plans. If your insurer fails to decide the appeal within the required timeline or refuses to consider your appeal, you can file a complaint at https://www.tdi.texas.gov/.

External review in Texas

Texas runs the Independent Review Organization (IRO) for external review of denied health-insurance claims. After your internal appeal is denied, you have 120 days to request external review. The independent reviewer is not affiliated with your insurer, and the decision is binding under federal and state law.

You can request external review at https://www.tdi.texas.gov/consumer/cpmiro.html.

Texas uses certified IROs randomly assigned by TDI. Insurer pays the cost.

How InsureDefense supports Texas appeals

Our standard tiers prepare your internal appeal with citations to the relevant Texas appeal-rights provisions. After internal appeal, our External Review Pack ($199) prepares the state-specific submission packet for the Independent Review Organization (IRO).

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Frequently asked questions

What state agency handles health insurance complaints in Texas?

The Texas Department of Insurance is the state agency that handles complaints about health insurers operating in Texas. You can file a complaint at https://www.tdi.texas.gov/.

How does external review work in Texas?

Texas uses the Independent Review Organization (IRO). After your internal appeal is denied, you generally have up to 120 days to request external review. The review is conducted by an Independent Review Organization that is not affiliated with your insurer, and its decision is binding. Texas uses certified IROs randomly assigned by TDI. Insurer pays the cost.

How long do I have to file an internal appeal in Texas?

Under federal ACA rules, Texas consumers generally have 180 days from receiving the denial notice. The exact deadline is on the denial letter — some plans allow longer windows than the federal minimum.

What if my employer plan is self-funded?

Self-funded employer plans in Texas are regulated by federal ERISA rules rather than state insurance law. They still have appeal rights — including external review — but the external-review process often uses the federal HHS-administered procedure instead of Texas's Independent Review Organization (IRO).

Not legal, medical, or insurance advice.

InsureDefense is not a law firm, insurer, medical provider, or claims adjuster. We do not provide legal, medical, or insurance advice. We prepare appeal documents based on the information you provide. We do not guarantee approval, payment, coverage, or reimbursement. For urgent medical situations, contact your doctor, insurer, or emergency services directly.