External review in Delaware: deadline, cost and how to ask
Delaware runs its own independent review of denials: Independent Health Care Appeals Program (IHCAP). 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 Delaware
- Program
Independent Health Care Appeals Program (IHCAP)
- Who runs it
- Delaware Department of Insurance, which assigns an Independent Utilization Review Organization (IURO): Health plans of health carriers regulated in Delaware (denials based on medical necessity or appropriateness of services)
- Deadline to ask
4 months
File your request for external review with your health carrier within 4 months of the date the carrier issued its final decision. The Department's procedure counts from the letter date, not the date you received it.
- The deadline runs from
The date the carrier's final internal appeal decision was issued (the date on the letter)
- Do I have to appeal to my plan first?
You must first complete the carrier's internal appeals process. You do not have to if you have an emergency medical condition, if the carrier waived the requirement or did not follow the federal internal appeal rules, or if you apply for expedited external review at the same time as an expedited internal appeal.
- Cost
External review is free for you. The carrier pays all costs of the review, including the Department's $75 administration fee.
- What can be reviewed
Final carrier decisions to deny, reduce or terminate benefits based on medical necessity or appropriateness of services. Denials on other grounds go to the Department of Insurance's arbitration process instead; if it is unclear which applies, the IURO reviews it.
- Is the decision final?
The IURO decision is binding on the carrier. If the carrier wins, that creates a rebuttable presumption in any later court case you bring. If you win, the carrier can appeal to Superior Court, which appoints an independent attorney to defend the decision at the carrier's expense.
- How to ask
Send your written request for external review to your health carrier. The carrier must send a copy to the Department of Insurance, which assigns an IURO. The IURO will write to you; you have 7 days after that notice to send more information. People in a Multi-State Plan request external review from the U.S. Office of Personnel Management at (855) 318-0714 or mspp@opm.gov.
Law: 18 Del. C. 6416, 6417(b); 18 DE Admin. Code 1301-5.0 to 8.0; DOI, Procedure for IHCAP applications (04/2019)
- Forms and online request
- Phone
Write my appeal: free letters
Sources
The official sources for Delaware are listed on the Delaware page.