Health insurance or Medicaid said no in Colorado? Deadlines and free help

In Colorado, your health plan is regulated by Colorado Division of Insurance (DOI), Department of Regulatory Agencies, if it is a state-regulated plan.

Colorado runs its own independent review of denials: Independent External 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.

Pick your plan type

Which kind of coverage was denied? The plan type decides which rules and deadlines apply.

Insurance I bought or got through work

Your state insurance rules may apply. First appeal to your plan, then ask for an outside review.

My employer pays claims itself (self-funded)

Federal rules apply, and most state insurance laws do not. Free help comes from the U.S. Department of Labor.

Medicaid / Health First Colorado

You ask the state for a fair hearing. In a Medicaid health plan, you usually appeal to the plan first.

Marketplace (Connect for Health Colorado) decision

A decision about whether you can buy a plan or get financial help is appealed to the Marketplace.

How long do I have?Urgent care: faster decisionWrite my appealFree help

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.

How long do I have in Colorado?

Appeal to your plan
At least 180 days from receipt of the denial (federal rule)
Outside review
4 months
Hearing deadline
60 days
Appeal to the plan first
60 days (federal rule)
Then a state hearing
120 days
Appeal deadline – Connect for Health Colorado
60 days

All the details →

How long do I have? Deadline calculator

How do I know which plan type I have?

How to tell which agency regulates your plan

Contact the Division of Insurance if you bought insurance yourself or have insurance from an employer that does business only in Colorado. If your coverage is through a self-insured employer (often a large company or one with locations in several states), contact the U.S. Department of Labor's Employee Benefits Security Administration.

Step 1: Appeal to your plan in Colorado

What it is called: Internal appeal (first-level and optional second-level review)

Group (employer) plans must offer two levels of internal review: a written first-level appeal reviewed by a physician who was not involved in the denial, and an optional second-level review where you can attend in person or by phone, bring a lawyer, advocate or health professional, and present materials. Individual plans offer one level, and you can choose a written appeal or an appeal review meeting. The review is recorded on audio or video unless neither you nor the plan wants that. A plan must answer an urgent care request within 72 hours. If a plan denies a service as excluded and a licensed doctor gives evidence that the exclusion does not apply, the denial can go through the appeal and external review process.

Law: C.R.S. 10-16-113(1)(c), (3)(a)(IV), (3)(b), (4)

All the details →

Step 2: Outside review in Colorado

Independent External Review

Deadline to ask: 4 months.

All the details →

Urgent care in Colorado: faster decisions

Appeal to your plan

  • Your plan must decide an urgent appeal within 72 hours.

Outside review

Expedited review is for cases where the normal time frame would seriously jeopardize your life or health or your ability to regain maximum function, and for denials about an admission, availability of care, a continued stay, or emergency services when you have not been discharged. Tell your insurance company that you want an expedited review. Your doctor must give the medical reason. The reviewer must decide within 72 hours.

Law: C.R.S. 10-16-113.5

Medicaid

If waiting could put your life or health at risk, ask for a faster (expedited) appeal when you request the hearing and explain the health reason. If approved, HCPF calls you to set up a hearing and decides within 3 business days for a service issue or 7 business days for an eligibility issue.

Complaints about your plan in Colorado

You can file a complaint with the Division of Insurance through its online Consumer Portal (you create an account first) or by mailing the printable Complaint Form / Request for Assistance. Questions: 303-894-7490 or 800-930-3745, DORA_Insurance@state.co.us. Pharmacy benefit manager (PBM) problems, such as drug coverage denials, can also be reported to the Division.

doi.colorado.gov

Medicaid (Health First Colorado) denials in Colorado

Who holds the hearing: Colorado Office of Administrative Courts (OAC); the HCPF Office of Appeals issues the final agency decision and handles approved expedited hearings.

Hearing deadline: 60 days

All the details →

Marketplace decisions in Colorado

Marketplace

Connect for Health Colorado · Office of Appeals 1-855-492-2420 (303-590-9640)

Appeal deadline

60 days

The date of your notice of determination (the letter with your application results)

How to appeal

Fill out the Appeal Request Form and upload it in your Connect for Health Colorado account under "Documents and Notices" (preferred), fax it to 303-322-4217, or mail it to Office of Appeals, 4600 South Ulster Street, Suite 300, Denver, CO 80237. You can appeal decisions about premium tax credits (APTC), cost-sharing reductions, eligibility to enroll in a plan, and a failure to send a timely eligibility notice. Medicaid and CHP+ denials go to your county office instead.

Form

Connect for Health Colorado Appeal Request Form

If you disagree

If you disagree with the Office of Appeals' decision, you can appeal to the U.S. Department of Health and Human Services within 30 days of that decision.

Law: 45 CFR 155.520

Other rights in Colorado

Prior approval time limits and "deemed approved"

For care requested on or after January 1, 2026, a plan must tell you and your provider within 5 business days whether a prior approval request is approved, denied or incomplete, and within 2 business days (but no more than 72 hours) for urgent care. If the plan misses these limits, the request is deemed approved. If the plan says the request is incomplete, your provider has 2 business days to send the missing information.

Law: C.R.S. 10-16-112.5(3)

Mental health and substance use denials

A denial of mental health, behavioral health or substance use disorder services must tell you, in plain language, about federal parity protections, how to contact the Division of Insurance or the state Office of the Ombudsman for Behavioral Health Access to Care, and that you can get the medical necessity criteria free of charge.

Law: C.R.S. 10-16-113(3)(c)

Who signs a denial

Written denials based on medical judgment must be signed by a licensed physician familiar with Colorado standards of care (a dentist for dental denials).

Law: C.R.S. 10-16-113(5)

How long do I have? Deadline calculator

Pick your plan type and enter the dates on your notice. We count from the rules in Colorado and the federal rules.

Worked out in your browser. Nothing you enter here is saved or sent.

If you are not sure when it arrived, use the date printed on the notice. That date is never later than the day it arrived.

Choose what was decided and enter the date on your notice

We add the number of days or months from the law to your date. Nothing is saved.

Write my appeal: free letters

Free help in Colorado

Good to know in Colorado

  • In Colorado you send your external review request to your insurance company, which must contact the Division of Insurance so the Division can assign the independent reviewer.

    Law: C.R.S. 10-16-113.5(5), (9)

  • Colorado's external review can also decide whether the state's out-of-network (surprise billing) protections apply to your care.

    Law: C.R.S. 10-16-113.5(8.5)

  • Connect for Health Colorado gives 60 days to appeal an eligibility decision, shorter than the 90 days used by HealthCare.gov (Connect for Health Colorado, Filing an Appeal).

Changes in 2024–2026

HB 24-1149 (2024) changed Colorado's prior authorization law for conduct on or after January 1, 2026: 5 business days for standard requests, 2 business days (no more than 72 hours) for urgent ones, and requests are deemed approved if the plan misses the deadline. HB 23-1225 (2023) added external review for drugs withdrawn from the Colorado market. HB26-1139 (signed June 2, 2026; effective January 1, 2027): carriers, managed care entities and others that use artificial intelligence in utilization review may not deny coverage based on medical necessity solely on an AI system's output without review by a licensed clinician or other competent regulated professional (Colorado General Assembly, HB26-1139).

Law: C.R.S. 10-16-112.5; C.R.S. 10-16-113.5(2)(a)(V)

Questions about appeals in Colorado

How long do I have to appeal a health insurance denial in Colorado?

You must ask for a first-level internal appeal within 180 days of receiving the denial. You have at least 180 days (about 6 months) from when you receive the denial notice to file an internal appeal.

How do I get an outside (external) review in Colorado?

Independent External Review. Send your request to your insurance company, following the instructions in the internal appeal denial letter. The company contacts the Division of Insurance, which picks the independent review organization, and the company then tells you in writing who it is.

Is outside review free in Colorado?

The insurance company pays the cost of the external review. There is no minimum claim amount.

How long do I have to ask for a Medicaid fair hearing in Colorado?

60 days. The date on your Notice of Action

Can I keep my Medicaid benefits while I appeal in Colorado?

If you are a current member and your coverage is ending, or a service you already get is being reduced or stopped, your benefits continue until a final decision if the Office of Administrative Courts gets your appeal no later than 10 days after the date of action (the date the change takes effect). There is no continuation for a first-time application or for a new service that was denied.

How do I appeal a Marketplace decision in Colorado?

Fill out the Appeal Request Form and upload it in your Connect for Health Colorado account under "Documents and Notices" (preferred), fax it to 303-322-4217, or mail it to Office of Appeals, 4600 South Ulster Street, Suite 300, Denver, CO 80237. You can appeal decisions about premium tax credits (APTC), cost-sharing reductions, eligibility to enroll in a plan, and a failure to send a timely eligibility notice.

Not about a denied claim?

Nearby states

Sources

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