Health insurance or Medicaid said no in Idaho? Deadlines and free help

In Idaho, your health plan is regulated by Idaho Department of Insurance (DOI), Consumer Affairs, if it is a state-regulated plan.

Idaho runs its own independent review of denials: External Review (Idaho Health Carrier External Review Act). 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.

Idaho Medicaid

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

Marketplace (Your Health Idaho) 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 Idaho?

Appeal to your plan
At least 180 days from receipt of the denial (federal rule)
Outside review
4 months
Hearing deadline
30 days
Appeal to the plan first
60 days (federal rule)
Appeal deadline – Your Health Idaho
30 days

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How long do I have? Deadline calculator

How do I know which plan type I have?

How to tell which agency regulates your plan

Most individual and fully insured group health plans qualify for Idaho's external review. Supplemental or limited-benefit plans, long-term care, Medicare, Medicaid and the Federal Employees Health Benefit Program do not.

Law: Idaho Code 41-5904

Step 1: Appeal to your plan in Idaho

What it is called: Grievance (internal appeal) with your health carrier

Follow your plan's internal grievance process as explained in your policy, coverage booklet or Explanation of Benefits. If the plan has not given you a written decision within 35 days after you filed a grievance (or 3 business days for an urgent pre-service or ongoing-care request), you may go to external review.

Law: Idaho Code 41-5907(1)(b)

All the details →

Step 2: Outside review in Idaho

External Review (Idaho Health Carrier External Review Act)

Deadline to ask: 4 months.

All the details →

Urgent care in Idaho: faster decisions

Outside review

Expedited review is for urgent care requests: care related to an admission, continued stay or service after emergency care when you have not been discharged, or pre-service or ongoing care where the standard time could seriously jeopardize your life, health or ability to regain maximum function, would cause severe pain that cannot be managed without the care (in your doctor's opinion), or would make the treatment significantly less effective. Your treating provider must certify the urgency on the request form. Call Consumer Affairs before sending the paperwork. The reviewer must decide within 72 hours and confirm in writing within 48 hours.

Law: Idaho Code 41-5907, 41-5908, 41-5909, 41-5910, 41-5915; IDAPA 18.04.01

Standard: 42 days

Marketplace

If you need health services right away and waiting could seriously jeopardize your life, health or ability to attain, maintain or regain maximum function, ask for an expedited appeal by calling 1-855-944-3246 or by putting "Medically Urgent" in the email subject line.

Law: 45 CFR 155.500-155.555

Complaints about your plan in Idaho

For other problems with your health insurance, contact Idaho DOI Consumer Affairs by phone or through its online contact form. If your insurer says your external review request is not eligible, you can appeal that decision to the DOI.

doi.idaho.gov

Medicaid (Idaho Medicaid (Medicaid for Adults, Children's Medicaid and CHIP)) denials in Idaho

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

Hearing deadline: 30 days

All the details →

Marketplace decisions in Idaho

Marketplace

Your Health Idaho · 1-855-944-3246 (TTY 1-800-377-3529)

Appeal deadline

30 days

The date Your Health Idaho mailed or emailed your Eligibility Notice

How to appeal

Complete the Appeal Request Form and email it to appeals@yourhealthidaho.org with "Appeal Request" in the subject line ("Medically Urgent" for an urgent appeal), mail it to Your Health Idaho, P.O. Box 50143, Boise, ID 83705, deliver it in person to 1501 S. Federal Way, Suite 100, Boise, or call 1-855-944-3246. The filing date is the date of your email, postmark or call. Your Health Idaho first tries to resolve the issue informally; if you are not satisfied, you must ask within 10 days of the date of the informal resolution decision to schedule a hearing before the Appeals Hearing Committee, and you get written notice of the hearing at least 15 days before it.

Form

Your Health Idaho Appeal Request Form

Faster appeal

If you need health services right away and waiting could seriously jeopardize your life, health or ability to attain, maintain or regain maximum function, ask for an expedited appeal by calling 1-855-944-3246 or by putting "Medically Urgent" in the email subject line.

Coverage while you appeal

You may be able to keep your eligibility for coverage while your appeal is pending; Your Health Idaho's letter will explain.

Law: 45 CFR 155.500-155.555

Other rights in Idaho

Medicaid service decisions have a shorter deadline

If DHW makes a decision about the Medicaid services you get, such as developmental disability services or level of care, you have 28 days from the date on the notice to appeal. Eligibility decisions have 30 days.

External review can be final

For health plans not covered by ERISA, Idaho law makes the external review decision final and binding on you and the insurer, and no lawsuit is allowed on the issues it decided.

Law: Idaho Code 41-5910(1)

How long do I have? Deadline calculator

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

Good to know in Idaho

  • Idaho's standard external review must be decided within 42 days.

    Law: Idaho Code 41-5908(20)

  • Idaho's 4-month external review deadline runs from the date the final denial notice was issued.

    Law: Idaho Code 41-5908(1)

  • Your Health Idaho gives 30 days, not 90, to appeal a Marketplace eligibility decision (Your Health Idaho Appeal Request Form).

Changes in 2024–2026

Since July 1, 2024, Medicaid and other DHW fair hearings are conducted by the Idaho Office of Administrative Hearings (OAH) under the DHW rules in effect before that date, as set out in OAH General Order No. 1 (DHW, Appeals and Fair Hearings).

Questions about appeals in Idaho

How long do I have to appeal a health insurance denial in Idaho?

State 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 Idaho?

External Review (Idaho Health Carrier External Review Act). Fill out the Health Claims External Review Request Form and send it to Idaho Department of Insurance, ATTN: External Review, P.O. Box 83720, Boise, ID 83720-0043 (fax 208-334-4398), with a copy of your insurance ID card, a copy of the plan's final denial letter, and a copy of your certificate of coverage or benefit booklet. You can also deliver it to 700 W. State St., 3rd Floor, Boise. For an urgent request, add the treating provider's certification and call Consumer Affairs before sending it.

Is outside review free in Idaho?

Your insurance company pays the cost of the external review.

How long do I have to ask for a Medicaid fair hearing in Idaho?

30 days. The date on your notice about the eligibility decision

Can I keep my Medicaid benefits while I appeal in Idaho?

To keep getting benefits while your appeal is considered, you must tell DHW within 10 days of the date of the notice. If your appeal is denied, you must repay the benefits you got during that time.

How do I appeal a Marketplace decision in Idaho?

Complete the Appeal Request Form and email it to appeals@yourhealthidaho.org with "Appeal Request" in the subject line ("Medically Urgent" for an urgent appeal), mail it to Your Health Idaho, P.O. Box 50143, Boise, ID 83705, deliver it in person to 1501 S. Federal Way, Suite 100, Boise, or call 1-855-944-3246. The filing date is the date of your email, postmark or call.

Not about a denied claim?

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