External review in Arizona: deadline, cost and how to ask
Arizona runs its own independent review of denials: External independent review. You generally have 4 months to ask for it.
External review means a doctor or reviewer outside your plan decides again. Internal appeal means your plan looks at its own decision again.
Checked against official sources: October 30, 2026.
Appeal deadlines are strict. If you are near a deadline or your care is urgent, call free help today.
Step 2: Outside review in Arizona
- Program
External independent review
- Who runs it
- Arizona Department of Insurance and Financial Institutions (DIFI), which assigns an independent review organization: Health insurance policies and HMO plans regulated by Arizona, including insured employer plans
- Deadline to ask
4 months
You have four months after you receive the written notice of the final internal denial to ask for an external independent review. A document sent by mail is treated as received on the fifth business day after mailing.
- The deadline runs from
The date you receive the written notice of the insurer's final internal appeal decision (or expedited appeal decision)
- Do I have to appeal to my plan first?
You must finish all of the insurer's internal levels of review first, unless the insurer did not follow the appeal rules (then you can start an expedited external review at the same time) or the insurer waived its internal appeal. You can also go to expedited external review after an expedited appeal is denied, or when care is denied while you are still in the hospital after emergency care, or when an admission or ongoing course of treatment is cut short.
- How long the review takes
Standard: 21 days; Urgent: 72 hours
- Cost
You do not pay for the external independent review. Your insurer's appeal information packet must say that you are not responsible for its costs.
- What can be reviewed
Medical necessity and appropriateness decisions (including health care setting, level of care or effectiveness of a covered benefit) and experimental or investigational denials go to an independent review organization. Disputes over whether a service is covered at all are decided by the DIFI director (within 15 business days). The reviewer cannot order coverage of a service that your contract excludes.
- Is the decision final?
The decision is a final administrative decision. Your insurer must provide the service or pay the claim found to be covered and medically necessary without delay, even if someone asks a court to review the decision.
- How to ask
Send a written request for external independent review to your insurer's utilization review agent (the contact named in your plan's appeal information packet and denial letter), with any documents that support your request. Within 5 business days the utilization review agent must acknowledge it and send your file to DIFI. You then have 5 business days after receiving the acknowledgment to send more written evidence to DIFI.
Law: A.R.S. 20-2533(H), (J), 20-2537, 20-2538 (as amended by Laws 2024, ch. 178 (HB 2599), effective January 1, 2025)
- Phone
Write my appeal: free letters
Sources
The official sources for Arizona are listed on the Arizona page.