External review in Illinois: deadline, cost and how to ask
Illinois runs its own independent review of denials: External Review (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.
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 Illinois
- Program
External Review (Health Carrier External Review Act)
- Who runs it
- Illinois Department of Insurance, Office of Consumer Health Insurance (assigns an approved independent review organization): Insured health plans and HMOs regulated in Illinois
- Deadline to ask
4 months
You must file within 4 months after you receive the denial notice. State law gives no extension.
- The deadline runs from
The date you receive the notice of the adverse determination or final adverse determination (denial)
- Do I have to appeal to my plan first?
You usually must finish your plan's internal appeal first. You are treated as having finished it if the plan has not decided your appeal within 30 days (care not yet received or ongoing care) or 60 days (care already received), or within 48 hours for an expedited appeal, unless you agreed to a delay. You can also skip it if the plan waives it, if waiting would seriously jeopardize your life, health or ability to regain maximum function, if the denial says the treatment is experimental and your doctor certifies it would be significantly less effective if not started promptly, or if the plan did not follow state or federal appeal rules.
- When you can go without a plan answer
30 days after you file your internal appeal
- Cost
External review is free for you. The health plan pays the full cost.
- What can be reviewed
Denials that involve medical judgment (medical necessity, appropriateness, level of care, health care setting, length of treatment, effectiveness of a benefit), experimental or investigational treatment, pre-existing conditions, and rescission of coverage for a reason other than unpaid premiums. Limited coverage such as dental-only, vision-only, specified-disease, hospital indemnity, long-term care or Medicare supplement policies are not covered.
- Is the decision final?
The decision is binding on the plan. It is binding on you except where you have other remedies under federal or state law. You cannot ask for a second external review of the same denial.
- How to ask
Send the Request for External Review form to the IDOI online through the IDOI Help Center, by email to DOI.externalreview@illinois.gov, by fax to 217-557-8495, or by mail to Illinois Department of Insurance, 4800 Wabash Avenue, Springfield, IL 62711. Attach a copy of the final denial letter (for expedited review, the latest denial letter), a copy of your insurance ID card, and any medical records or other papers you want the reviewer to see. Add the physician certification form for urgent or experimental cases, and the authorized representative form if someone files for you. Send copies only and keep your originals. After the review is accepted, you have 5 business days to send more information to the reviewer.
Law: 215 ILCS 180/20, 25, 30, 35, 40, 42, 45, 70
- Forms and online request
- Phone
1-877-850-4740 (TDD 1-866-323-5321)
Write my appeal: free letters
Sources
The official sources for Illinois are listed on the Illinois page.