US Medical Term · insurance
Deemed Exhaustion
Agotamiento Presunto
In 9 languages
| Language | Term |
|---|---|
| English | Deemed Exhaustion |
| Spanish (Español) | Agotamiento Presunto |
| Chinese (中文) | 视为穷尽内部申诉 |
| Korean (한국어) | 간주 소진 |
| Vietnamese (Tiếng Việt) | Coi như đã cạn kiệt |
| Filipino (Tagalog) | Itinuturing na Naubos |
| Portuguese (Português) | Esgotamento Presumido |
| Thai (ภาษาไทย) | ถือว่าใช้สิทธิ์ครบถ้วนแล้ว |
| Japanese (日本語) | みなし不服申し立て完了 |
What it means
Deemed exhaustion is a legal status that allows you to skip your health plan's internal appeal process and request external review immediately, when your insurer has failed to follow required federal or state appeal rules. Under the ACA, health plans must process appeals within strict timeframes and follow specific procedural rules. If a plan violates these requirements—for example, by missing a decision deadline, failing to provide adequate notice, or not having a proper appeals process in place—you are deemed to have exhausted internal remedies even without completing them. This lets you go directly to an Independent Review Organization (IRO) for an external review. Deemed exhaustion is an important patient protection that prevents insurers from delaying or denying external review through procedural failures.
How to say it
Sentences a patient might use with a doctor, nurse, pharmacist, or insurer:
My insurer missed the deadline to decide my appeal, so I qualified for deemed exhaustion.
Mi aseguradora no cumplió el plazo para decidir mi apelación, así que califiqué para el agotamiento presunto.
With deemed exhaustion, I can request external review without finishing the internal process.
Con el agotamiento presunto, puedo solicitar una revisión externa sin terminar el proceso interno.
Deemed exhaustion protects patients when insurers fail to follow proper appeal procedures.
El agotamiento presunto protege a los pacientes cuando las aseguradoras no siguen los procedimientos de apelación adecuados.
Where you'll see it
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Sources
Last reviewed: September 2026