External review in Iowa: deadline, cost and how to ask
Iowa runs its own independent review of denials: External Review. 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 Iowa
- Program
External Review
- Who runs it
- Iowa Insurance Division (assigns an Independent Review Organization): Insured health benefit plans from health carriers regulated in Iowa (not Medicaid, Medicare or self-insured employer plans)
- Deadline to ask
4 months
File your written request with the Iowa Insurance Division within 4 months after you receive the final adverse determination (or within 4 months after the carrier missed its 30-day grievance deadline or agreed to skip the internal process).
- The deadline runs from
The date you receive the final adverse determination (or 30 days after filing a grievance with no written decision, or the date the carrier agreed to skip the internal process)
- Do I have to appeal to my plan first?
You must usually finish the carrier's internal grievance process first. You can go straight to external review if the carrier has not decided your grievance within 30 days, if the carrier waives the internal process, if you need an expedited review because waiting would seriously jeopardize your life, health or ability to regain maximum function, or, for an experimental or investigational denial, if your treating physician certifies in writing that the treatment would be significantly less effective if not started promptly.
- When you can go without a plan answer
30 days after you file your internal appeal
- Cost
External review is free for you. The insurance company pays the cost of the independent review organization.
- What can be reviewed
Denials, reductions or terminations because the carrier said a covered service did not meet its requirements for medical necessity, appropriateness, health care setting, level of care or effectiveness; denials because a treatment is experimental or investigational. Services specifically excluded in your policy (other than these) do not qualify.
- Is the decision final?
The decision is binding on the insurance company. You or your representative can ask for judicial review in Polk County district court or the district court of your county within 15 business days after the decision.
- How to ask
Complete and sign the External Review Request Form and send it with the carrier's final denial letter (or proof that you filed an internal appeal and got no decision in 30 days, or the carrier's waiver) to the Iowa Insurance Division, 1963 Bell Avenue, Suite 100, Des Moines, Iowa 50315; fax 515-654-6500; email iid.marketregulation@iid.iowa.gov. For an expedited review, call first at 877-955-1212 or 515-654-6600. After the Division assigns an independent review organization, you can send more information directly to that organization.
Law: Iowa Code 514J.106-514J.110, 514J.115; Iowa Code 191 IAC 76
- Forms and online request
- Phone
Write my appeal: free letters
Sources
The official sources for Iowa are listed on the Iowa page.