Guides · Last reviewed October 20, 2026

How to appeal a Kaiser Permanente denial

Kaiser Permanente gives members 180 days from the denial notice to file an internal appeal, and decides most appeals within 30 days (72 hours if it's urgent). If it's denied, you can ask for an independent external review.

Why it's worth appealing

Across ACA Marketplace insurers, about 19% of in-network claims were denied in 2024, yet patients appealed fewer than 1% of those denials. When people did appeal, roughly one in three internal appeals ended with the denial overturned.

Step 1: Read your denial notice

Find the claim or reference number, your member ID, the exact reason for the denial, and the appeal deadline. Because Kaiser Permanente is both your plan and your care provider, a denial may be about a claim, a referral, or a service that was ruled not medically necessary.

Step 2: Know your deadline (usually 180 days)

For most plans you have 180 days from the date of the denial notice to file an internal appeal. Medicare and Medicaid plans follow their own timelines — for Medicare Advantage, see our Medicare appeal guide.

Step 3: Build your case

Write a letter explaining why you believe the denial was wrong, and attach a letter of medical necessity from your physician, relevant medical records or clinical guidelines, and a copy of the original denial notice.

Step 4: File the appeal with Kaiser Permanente

• Submit a written appeal at members.kp.org, or
• Call the Member Service Call Center at 1-800-788-0710 (TTY 711).

Kaiser Permanente generally decides within 30 days of receiving your appeal, and within 72 hours for an urgent (expedited) appeal. Keep copies of everything you send.

Step 5: Request an external review if denied

If the internal appeal is denied, you can request an independent external review. In California this is the Department of Managed Health Care's Independent Medical Review (IMR); other states have their own external review process. The outside reviewer's decision is binding, and the review is generally free.

Where to get free help

• Job-based plan that's self-insured: U.S. Department of Labor, EBSA — 1-866-444-3272.
• Job-based plan that's fully insured: HHS Health Insurance Assistance Team — 1-888-393-2789.
• Medicare: 1-800-MEDICARE, or see our Medicare appeal guide.

For the general step-by-step that applies to any insurer, see our guide to appealing a health insurance denial.

Common questions

Sources

• Kaiser Permanente: Member Grievances & Appeals Quick Reference Guide
• HealthCare.gov: External review
• KFF: Claims denials and appeals in ACA Marketplace plans in 2024

Billmira is a self-help information tool, not a law firm, and this isn't legal or medical advice. Billmira is not affiliated with or endorsed by Kaiser Permanente. Rules change and plans differ; check the official sources above and your own documents.