How We Research Health Appeal Rules

Each state has its own rules for who regulates your plan, outside review, Medicaid hearings and Marketplace appeals. This page explains where our information comes from and how the tools work.

Sources

Each state page is built from official sources only: the state's statutes and regulations on official websites, the state insurance department, the state Medicaid agency and its hearing office, the state Marketplace, and the federal consumer assistance and legal aid networks. National facts (the federal internal appeal and external review rules, the Medicaid fair hearing rules, Marketplace appeals and the Medicaid changes starting in 2027) come from the U.S. Code, the Code of Federal Regulations, the Federal Register, CMS, the Department of Labor and HHS. Each page lists its sources and the date it was checked.

How we check

Every state file is researched and then checked by a second, independent reviewer against the official text, with special care for deadlines, what each one runs from, business days versus calendar days, fees and links.
A state page is published only after that check. Until then, the state appears on our map and in our tables as "not covered yet," with its insurance department and Medicaid hearing page when we have them, the federal consumer assistance page and LawHelp.org.
Where we cannot verify something, we leave it out instead of guessing. We copy numbers exactly as the source states them and never round them. When a state number is missing and the data says the federal rule applies, the page says "federal rule."

The deadline calculator

The calculator adds the number of days or months in our data to the date on your notice. It uses the state's own number when the data has one and the federal rule when the data says the state follows it. For federal outside review it counts 4 months from receipt, and if the date does not exist in that month it uses the first day of the fifth month, and moves a weekend or federal holiday to the next business day, as the federal rule says. It never counts business days as calendar days: a deadline counted in business days is shown in words only. For Medicaid it asks whether your decision is about a service or about eligibility, because some states have two deadlines, and it never shows a later date than the rule that applies. A notice may give an earlier date, and the notice controls.

The letters and the checklist

The letters put what you type into full sentences: an appeal to your plan, a request for your claim file, a request for outside review, a Medicaid fair hearing request and an appeal to a Medicaid health plan. They are made on your device in English, because they go to plans and agencies in the United States; on Spanish pages a Spanish explanation is shown beside the text. When you download, copy or print one, we save only your name, phone or email, state and the document type, never health details, as our privacy policy explains.

What we never do

We never say that an appeal will win, that a person qualifies or that a service will be covered, and we never judge anyone for asking. A consumer assistance program, a legal aid office or a lawyer can look at your whole situation.

Report an error

Email us at hello@robinclaim.com with a link to the official source and we will check it.