Health insurance or Medicaid said no in the District of Columbia? Deadlines and free help

In the District of Columbia, state-regulated health plans are overseen by DC Department of Insurance, Securities and Banking (DISB), Consumer Services Division and DC Office of Health Care Ombudsman and Bill of Rights (Department of Health Care Finance).

The District of Columbia runs its own independent review of denials: External Appeal (Health Benefits Plan Members' Bill of Rights). 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.

DC Medicaid

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

Marketplace (DC Health Link) 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 the District of Columbia?

Appeal to your plan
At least 180 days from receipt of the denial (federal rule)
Outside review
4 months
Hearing deadline
90 days
Appeal to the plan first
60 days (federal rule)
Then a state hearing
120 days
Appeal deadline – DC Health Link
90 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

For a denied claim after your plan's internal appeal, go to the Office of Health Care Ombudsman and Bill of Rights for an external appeal. For other problems with an insurance company regulated in DC, and for appeals of a rescission, contact DISB. Medicare and Medicaid have their own appeal processes; self-insured employer plans go to the U.S. Department of Labor.

Law: Ombudsman, Grievances/Appeals Fact Sheet (rev. 9/15/2025); D.C. Code 44-301.06a, 44-301.07(q)

Step 1: Appeal to your plan in the District of Columbia

What it is called: Internal appeal (Health Benefits Plan Members' Bill of Rights)

The insurer must acknowledge your appeal in writing within 10 business days. It must decide an appeal about an urgent or emergency medical condition within 24 hours, other appeals within 30 calendar days for prospective reviews and 60 calendar days for retrospective reviews. On request you keep coverage at your previous level while the appeal is pending. You can review your file, get free copies of all relevant documents, present evidence and testimony, and see any new evidence or rationale. The reviewers must not have been involved in the first decision, and at least one must be in the same specialty. The insurer's denial letter must explain the decision and tell you how to file an external appeal.

Law: D.C. Code 44-301.06

All the details →

Step 2: Outside review in the District of Columbia

External Appeal (Health Benefits Plan Members' Bill of Rights)

Deadline to ask: 4 months.

All the details →

Urgent care in the District of Columbia: faster decisions

Appeal to your plan

  • Your plan must decide an urgent appeal within 24 hours.

Outside review

Expedited appeals are available for admission, continued stay or care after emergency services when you have not been discharged, for an emergency or urgent medical condition, and for experimental or investigational treatment when your doctor certifies it will be much less effective if not started promptly. The review organization must decide within 72 hours of assignment. The Ombudsman's office tells you within 24 hours in urgent cases whether your appeal was accepted (5 business days otherwise).

Law: D.C. Code 44-301.07

Complaints about your plan in the District of Columbia

If your insurance company does not fix a problem, you can ask DISB's Consumer Services Division for help online, with the complaint form by email, or by mail to 1050 First St. NE, Suite 801, Washington, DC 20002. DISB can investigate whether the insurer had a good faith reason to deny your medical claim or broke your agreement or DC law, but cannot make medical decisions. If an insurer upholds a rescission of your coverage, you can appeal to DISB.

Law: D.C. Code 44-301.06a

disb.dc.gov

Medicaid (DC Medicaid (also DC Healthy Families; the DC Health Care Alliance is a local program)) denials in the District of Columbia

Who holds the hearing: DC Office of Administrative Hearings (OAH).

Hearing deadline: 90 days

All the details →

Marketplace decisions in the District of Columbia

Marketplace

DC Health Link · 1-855-532-5465

Appeal deadline

90 days

The postmark of the notice telling you about the eligibility decision

How to appeal

Call DC Health Link Customer Service at 1-855-532-5465; or fill out a Request for Hearing form and fax it to 202-724-2041 or email it to DC.OARA@DC.GOV; or go to any DHS Service Center or the OAH Resource Center (441 4th Street NW, Suite 450-North) and fill out the form. You are first offered a voluntary Administrative Review Conference with a DHS hearing examiner; if you disagree, the case goes to a fair hearing before an OAH administrative law judge.

Coverage while you appeal

If you already get premium tax credits or cost-sharing help, you can stay in your plan with the same level of help during the appeal; if you lose, you may owe back the extra help.

If you disagree

The judge's written decision tells you what you can do if you disagree.

Law: D.C. Code 4-210.09; D.C. Code 45 CFR 155.520

Other rights in the District of Columbia

In-person hearing before the review organization

In a DC external appeal, you or your representative (and one insurer representative) can ask to appear in person before the independent review organization at a hearing held in DC, present your case, submit material and ask questions.

Law: D.C. Code 44-301.07(k)

Keep coverage during the internal appeal

On request, you keep coverage at the level you had before a reduction, termination or limit while your internal appeal is pending.

Law: D.C. Code 44-301.06(e)

Mental health information

If continuing the internal appeal would require sharing mental health information you or your mental health professional consider confidential, you can go straight to external appeal, and disclosures are limited under DC's mental health information law.

Law: D.C. Code 44-301.06(b)(6), (i); D.C. Code 44-301.07(f)

How long do I have? Deadline calculator

Pick your plan type and enter the dates on your notice. We count from the rules in the District of Columbia 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 the District of Columbia

Good to know in the District of Columbia

  • DC decides urgent internal appeals within 24 hours, faster than the federal 72 hours.

    Law: D.C. Code 44-301.06(f)

  • DC external appeals are filed with the Office of Health Care Ombudsman and Bill of Rights within 4 months, and you can ask for an in-person hearing before the review organization.

    Law: D.C. Code 44-301.07(b), (k)

  • DC Medicaid gives 90 days from the postmark of the notice to ask OAH for a fair hearing.

Changes in 2024–2026

The Ombudsman revised its Grievances/Appeals Fact Sheet on September 15, 2025. OAH's e-filing and final order search portals were under maintenance as of October 21, 2026.

Questions about appeals in the District of Columbia

How long do I have to appeal a health insurance denial in the District of Columbia?

DC law does not set a longer time. Use the deadline on your denial notice; federal rules give at least 180 days for most plans. 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 the District of Columbia?

External Appeal (Health Benefits Plan Members' Bill of Rights). Send a letter with your documents (a copy of the insurer's decision and what it gave you about the denial) and a signed Authorization for Release of Medical Records to the Office of Health Care Ombudsman and Bill of Rights, One Judiciary Square, 441 4th Street NW, Suite 250 North, Washington, DC 20001 (fax 202-442-6724, email healthcareombudsman@dc.gov). You get at least 10 business days to send more information to the review organization.

Is outside review free in the District of Columbia?

There is no cost to file an external appeal.

How long do I have to ask for a Medicaid fair hearing in the District of Columbia?

90 days. The postmark date of the agency notice

Can I keep my Medicaid benefits while I appeal in the District of Columbia?

For a Medicaid eligibility decision, your Medicaid continues if you appeal before it ends or within 15 days of the date of the notice, whichever is later. If you appeal later but within 90 days, your appeal is still heard but coverage may not restart.

How do I appeal a Marketplace decision in the District of Columbia?

Call DC Health Link Customer Service at 1-855-532-5465; or fill out a Request for Hearing form and fax it to 202-724-2041 or email it to DC.OARA@DC.GOV; or go to any DHS Service Center or the OAH Resource Center (441 4th Street NW, Suite 450-North) and fill out the form. You are first offered a voluntary Administrative Review Conference with a DHS hearing examiner; if you disagree, the case goes to a fair hearing before an OAH administrative law judge.

Not about a denied claim?

Nearby states

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