External review in District of Columbia: deadline, cost and how to ask
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.
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 the District of Columbia
- Program
External Appeal (Health Benefits Plan Members' Bill of Rights)
- Who runs it
- DC Office of Health Care Ombudsman and Bill of Rights (for the Director of the Department of Health Care Finance), which assigns an independent review organization: HMO and health insurance plan members (not Medicare or Medicaid)
- Deadline to ask
4 months
File a written request within 4 months from receipt of the written decision of your insurer's internal appeal, with a signed release of your medical records.
- The deadline runs from
The date you receive the insurer's written internal appeal decision
- Do I have to appeal to my plan first?
You normally finish the internal appeal first. You can go straight to external appeal if your plan or the Director waives it, if the insurer did not meet the internal appeal deadlines or rules, in an emergency or urgent case (filing an expedited external appeal at the same time as an expedited internal appeal), or if continuing would require sharing mental health information you consider confidential.
- Cost
There is no cost to file an external appeal.
- What can be reviewed
Denials, reductions, limits, terminations, payment failures or delays about medical necessity, appropriateness, level of care or setting, experimental or investigational treatment, rescission, eligibility to participate in a plan, and wellness incentive issues. Medicaid and DC Health Care Alliance cases use their own fair hearing process; Medicare is also excluded.
- Is the decision final?
The decision of the independent review organization is binding on the plan or insurer and on you, except for other remedies under District or federal law.
- How to ask
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. You or a representative can ask to appear in person before the review organization at a hearing held in DC.
Law: D.C. Code 44-301.07
- Forms and online request
- Phone
Write my appeal: free letters
Sources
The official sources for the District of Columbia are listed on the District of Columbia page.