External review by state
Which states run their own independent review of denied health claims, how long you have to ask, and what it costs.
Appeal deadlines are strict. If you are near a deadline or your care is urgent, call free help today.
| State | Process | Program | Deadline to ask | Cost |
|---|---|---|---|---|
Federal process | — | 4 months (federal rule) | Up to $25 (federal rule) | |
State program | External Review | 180 days | Free | |
State program | External independent review | 4 months | Free | |
State program | External Review | 4 months | Free | |
State program | Independent Medical Review (IMR) | 6 months | Free | |
State program | Independent External Review | 4 months | Free | |
State program | External Review Program (Connecticut Insurance Department) | 120 days | Free | |
State program | Independent Health Care Appeals Program (IHCAP) | 4 months | Free | |
State program | External Appeal (Health Benefits Plan Members' Bill of Rights) | 4 months | Free | |
Federal process | — | 4 months (federal rule) | Up to $25 (federal rule) | |
Federal process | — | 4 months (federal rule) | Up to $25 (federal rule) | |
State program | External Review (Insurance Commissioner) | 130 days | Up to $15 | |
State program | External Review (Idaho Health Carrier External Review Act) | 4 months | Free | |
State program | External Review (Health Carrier External Review Act) | 4 months | Free | |
State program | External grievance (independent review) | 120 days | Free | |
State program | External Review | 4 months | Free | |
State program | External Review (Kansas Insurance Department) | 120 days | Free | |
State program | External Review | 60 days | Up to $25 | |
State program | External Review (Louisiana Health Plan Independent Review) | 4 months | Free | |
State program | Independent External Review | 12 months | Free | |
State program | Appeals and Grievance complaint to the Maryland Insurance Administration (review by an independent review organization) | 4 months | Free | |
State program | External Review (Office of Patient Protection) | 4 months | Up to $25 | |
State program | External review under the Patient's Right to Independent Review Act (PRIRA) | 120 days | Free | |
State program | External Review (External Appeal) | 6 months | Free | |
State program | Health Care External Review | 4 months | Free | |
State program | External review by an Independent Review Organization (IRO), through the Department of Commerce and Insurance | Missouri law does not currently set a time limit to ask DCI for external review. DCI asks you to contact it as soon as possible. | Free | |
State program | External Review | 120 days | Free | |
State program | External Review (Health Carrier External Review Act) | 4 months | Free | |
State program | External Review (Office for Consumer Health Assistance) | 4 months (federal rule) | Free | |
New Hampshire Not covered yet: State insurance department · CMS help page for this state · LawHelp.org | — | — | — | — |
State program | Independent Health Care Appeals Program (IHCAP) external appeal | 4 months | Free | |
State program | External review by an Independent Review Organization (IRO) appointed by the Superintendent of Insurance | 4 months | Free | |
State program | New York State External Appeal | 4 months | Up to $25 | |
State program | External Review (Health Insurance Smart NC) | 120 days | Free | |
State program | External Review | 4 months (federal rule) | Up to $25 | |
State program | External Review | 180 days | Free | |
State program | External Review | 4 months | Free | |
State program | External Review (independent review organization) | 180 days | Free | |
State program | Independent External Review | 4 months | Free | |
State program | External appeal by an independent review organization (IRO) | 4 months | Up to $25 | |
State program | External review (Health Carrier External Review Act) | 4 months | Free | |
State program | External Review | 4 months | Free | |
State program | External Review | 6 months | Free | |
Federal process | — | 4 months (federal rule) | Up to $25 (federal rule) | |
State program | Independent Review | 180 days | Free | |
State program | Independent External Review (Healthcare External Appeal) | 4 months | Up to $25 | |
State program | External Review | 120 days | Free | |
State program | Independent Review (Independent Review Organization, IRO) | 180 days | Free | |
State program | Independent External Review | 4 months | Free | |
Federal process | — | 4 months (federal rule) | Up to $25 (federal rule) | |
State program | Independent Medical Claim Review (External Review) | 120 days | Up to $15 |
Federal rule: Under the federal process you have 4 months from the date you receive the denial or final appeal decision to ask for external review. If there is no matching date 4 months later, the deadline is the first day of the fifth month. If the last day is a Saturday, Sunday or federal holiday, it moves to the next business day. State programs must allow at least 4 months; some allow more.
Law: 45 CFR 147.136(c)(2)(vi), (d)(2)(i)