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

In Indiana, your health plan is regulated by Indiana Department of Insurance (IDOI), Consumer Services, if it is a state-regulated plan.

Indiana runs its own independent review of denials: External grievance (independent review). You generally have 120 days 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.

Indiana Medicaid

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

Marketplace (HealthCare.gov) 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 Indiana?

Appeal to your plan
At least 180 days from receipt of the denial (federal rule)
Outside review
120 days
Hearing deadline
33 days
Appeal to the plan first
60 days (federal rule)
Appeal deadline – HealthCare.gov
90 days (federal rule)

All the details →

How long do I have? Deadline calculator

How do I know which plan type I have?

How to tell which agency regulates your plan

Employer self-funded plans, where your employer pays your medical bills instead of buying a health plan, are outside the IDOI's reach; the U.S. Department of Labor handles complaints about them. The IDOI also has no authority over FEHBP, Medicare, Medicaid or HIP.

Step 1: Appeal to your plan in Indiana

What it is called: Grievance and appeal of a grievance decision (with your insurer or HMO)

You can file a grievance by phone or in writing; your insurer must have a toll-free number for grievances. A grievance must be resolved within 20 business days after the insurer has the information it needs (10 more business days if it tells you in writing why it needs more time). You can then appeal the grievance decision. The appeal must be decided by a panel that includes someone in the same profession and a similar specialty, and you can appear in person or otherwise talk to the panel. The appeal must be resolved no later than 45 days after you file it.

Law: IC 27-8-28-14, 27-8-28-16, 27-8-28-17 (insurers); IC 27-13-10-8 (HMOs)

All the details →

Step 2: Outside review in Indiana

External grievance (independent review)

Deadline to ask: 120 days.

All the details →

Urgent care in Indiana: faster decisions

Outside review

If waiting for a standard review would seriously jeopardize your life or health or your ability to reach and maintain maximum function, ask for an expedited review. The reviewer must decide and tell you within 72 hours after you file. A standard review must be decided within 15 business days after you file, and you must be told within 72 hours after the decision.

Law: IC 27-8-29-12, 27-8-29-13, 27-8-29-14, 27-8-29-15, 27-8-29-16, 27-8-29-17; IC 27-13-10.1-1, 27-13-10.1-2, 27-13-10.1-4, 27-13-10.1-5

Standard: 15 business days

Complaints about your plan in Indiana

You can file a complaint with the IDOI online or by mailing or faxing the complaint form (fax 317-234-2103). The IDOI mails your complaint to the company, which by Indiana law has 20 business days to answer the IDOI in writing.

gov.sircon.com

Medicaid (Indiana Medicaid (Indiana Health Coverage Programs, including the Healthy Indiana Plan (HIP), Hoosier Healthwise, Hoosier Care Connect and Indiana PathWays for Aging)) denials in Indiana

Who holds the hearing: Indiana Office of Administrative Law Proceedings (OALP), FSSA Hearings.

Hearing deadline: 33 days

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Marketplace decisions in Indiana

Indiana uses HealthCare.gov. Appeals go to the federal Marketplace Appeals Center.

HealthCare.gov

1-855-231-1751

Other rights in Indiana

How fast a plan must decide a prior approval

Not counting weekends and holidays, a utilization review entity must answer an urgent prior authorization request within 24 hours and other requests (including prescription drugs) within 48 hours. A denial must give specific reasons and suggest alternatives. Your provider can appeal within 48 hours and the plan must answer within 48 hours. If the plan misses these deadlines, the service is automatically treated as authorized.

Law: IC 27-1-37.5-23, 27-1-37.5-28 (P.L.144-2025)

Who decides medical necessity

Denials based on medical necessity and appeals must be decided by a clinical peer under the direction of an Indiana-licensed physician medical director. The clinical peer cannot have a financial interest in the appeal or have made the original denial. Your provider can ask for a peer-to-peer review of a denial.

Law: IC 27-1-37.5-17, 27-1-37.5-20 (P.L.144-2025)

How long do I have? Deadline calculator

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

Good to know in Indiana

  • In Indiana you ask your insurer or HMO, not the state, for an external review, and you have 120 days after the appeal decision to do it.

    Law: IC 27-8-29-13; IC 27-13-10.1-2

  • Indiana's standard external review must be decided within 15 business days after you file.

    Law: IC 27-8-29-15

  • Indiana gives 33 days to appeal a Medicaid action, counted for current members from the effective date on the notice.

Changes in 2024–2026

2025: P.L.144-2025 rewrote Indiana's prior authorization law for insurers, HMOs and Medicaid risk-based managed care: 24-hour (urgent) and 48-hour (other) answer deadlines not counting weekends and holidays, clinical-peer review of denials and appeals, and automatic approval if the plan misses a deadline. Medicaid hearings once held by FSSA's Office of Hearings and Appeals are now heard by administrative law judges of the Office of Administrative Law Proceedings (OALP). Healthy Indiana Plan (HIP) work requirements start January 1, 2027 (at least 80 hours a month of qualifying activities, with exemptions); FSSA began sending notices in July 2026.

Law: IC 27-1-37.5-17 to -28, in the 2026 Indiana Code

Questions about appeals in Indiana

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

State law does not set a longer time to file. 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 Indiana?

External grievance (independent review). Send a written request for an external grievance review to your insurer or HMO (not to the state), using the address and instructions in your appeal decision letter. The insurer picks a certified independent review organization in rotation.

Is outside review free in Indiana?

You pay nothing. The insurer or HMO pays all costs of the independent review organization.

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

33 days. For people already getting Medicaid, the effective date of the action shown on the notice; for applications, the date the notice was sent

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

Your benefits continue without change if the DFR receives your appeal by 4:30 p.m. on the day before the effective date of the change (or the next business day if that day is not a business day). Benefits do not continue if you say you do not want them, or if the case closed for not paying a Medicaid premium or a HIP POWER account payment.

Who regulates health insurance in Indiana?

Indiana Department of Insurance (IDOI), Consumer Services. Employer self-funded plans, where your employer pays your medical bills instead of buying a health plan, are outside the IDOI's reach; the U.S. Department of Labor handles complaints about them. The IDOI also has no authority over FEHBP, Medicare, Medicaid or HIP.

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