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

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

Kentucky runs its own independent review of denials: External Review. You generally have 60 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.

Kentucky Medicaid

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

Marketplace (kynect (Kentucky Health Benefit Exchange)) 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 Kentucky?

Appeal to your plan
At least 180 days from receipt of the denial (federal rule)
Outside review
60 days
Hearing deadline
30 days
Appeal to the plan first
60 days (federal rule)
Then a state hearing
120 days
Appeal deadline – kynect (Kentucky Health Benefit Exchange)
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

If you bought insurance yourself or get it from an employer that does business only in Kentucky, contact the Kentucky Department of Insurance. If your coverage is through a self-insured employer (typically a large company or one with locations in several states), contact the U.S. Department of Labor, EBSA.

Step 1: Appeal to your plan in Kentucky

What it is called: Internal appeal

Your insurer must decide an internal appeal within 30 days of receiving it. An expedited appeal must be decided within 3 business days; you get one if you are in the hospital or your treating provider says the standard time could seriously jeopardize your health (or, if you are pregnant, your unborn child's), or seriously impair a bodily function or organ. A denial for medical reasons must be reviewed on appeal by a licensed physician who was not part of the first decision, and you can ask for a physician in the right specialty. Federal rules also apply and can require a faster urgent decision.

Law: KRS 304.17A-617(4)

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Step 2: Outside review in Kentucky

External Review

Deadline to ask: 60 days.

All the details →

Urgent care in Kentucky: faster decisions

Outside review

Expedited review applies if you are in the hospital, or your treating provider says the standard time could seriously jeopardize your health (or your unborn child's) or seriously impair a bodily function or organ. The insurer must send the request to the reviewer within 24 hours, and the reviewer decides within 24 hours of getting all the information from the insurer (one 24-hour extension is allowed if you and the insurer agree). You can ask orally, followed by a short written request.

Law: KRS 304.17A-619(1), 304.17A-623, 304.17A-625(9)-(10); KRS 806 KAR 17:290

Standard: 21 days; Urgent: 24 hours

Marketplace

You can ask for an expedited appeal if you need a health service right away and the standard appeal could seriously endanger your life, health or ability to attain, maintain or regain maximum function. Send proof of the reason.

Law: 900 KAR 10:130

Complaints about your plan in Kentucky

For coverage denials, you can ask the Department of Insurance in writing to review the denial after the internal appeal; the insurer must answer the Department within 10 business days. For other problems, file a complaint with the Department of Insurance online or by email (DOI.ConsumerComplaints@ky.gov).

Law: KRS 304.17A-617(5)

insurance.ky.gov

Medicaid (Kentucky Medicaid) denials in Kentucky

Who holds the hearing: Cabinet for Health and Family Services, Division of Administrative Hearings (the designated hearing agency).

Hearing deadline: 30 days

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Marketplace decisions in Kentucky

Marketplace

kynect (Kentucky Health Benefit Exchange) · 1-855-459-6328

Appeal deadline

30 days

The date of the notice of the eligibility determination or redetermination

How to appeal

Ask for an appeal by phone, by mail, in person or online. kynect first does a desk review (informal resolution) within 15 calendar days (3 business days if expedited). If you are not satisfied, your appeal goes to the Cabinet's Division of Administrative Hearings for a hearing before an impartial hearing officer.

Faster appeal

You can ask for an expedited appeal if you need a health service right away and the standard appeal could seriously endanger your life, health or ability to attain, maintain or regain maximum function. Send proof of the reason.

Coverage while you appeal

If you appeal a redetermination, you can keep your previous level of premium tax credit, cost-sharing reductions and plan while the appeal is pending (you may have to pay back extra tax credit at tax time). This does not apply to an appeal of a first-time denial of tax credits.

If you disagree

If you disagree with the decision, you can appeal to the U.S. Department of Health and Human Services within 30 days of the appeal notice, or seek judicial review under KRS 13B.140.

Law: 900 KAR 10:130

Other rights in Kentucky

Coverage denials reviewed by the Department of Insurance

If your insurer says a service is not covered under your policy (a 'coverage denial'), you can ask the Department of Insurance in writing to review it after the internal appeal. The Department contacts the insurer, which must respond within 10 business days.

Law: KRS 304.17A-617(5)

Step therapy exception denials

Denials of a step therapy exception request can also go to external review under Kentucky law.

Law: 806 KAR 17:290, Sections 1-2; KRS 304.17A-163

How long do I have? Deadline calculator

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

Good to know in Kentucky

  • Kentucky's statute gives 60 days after the internal appeal decision to ask for external review and charges a $25 filing fee that is waived for hardship and refunded if you win.

    Law: KRS 304.17A-623(4)-(5)

  • Kentucky Marketplace (kynect) eligibility appeals must be filed within 30 days of the notice, not 90 (900 KAR 10:130, Section 4(4)).
  • Kentucky Medicaid managed care members get 120 days after the plan's final appeal letter to request a state fair hearing (907 KAR 17:010, Section 5(3)).

Changes in 2024–2026

July 15, 2026: KRS 304.17A-623 (external review) was amended by 2026 Ky. Acts ch. 45, sec. 30.

Questions about appeals in Kentucky

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

State law does not give more time than the federal rules. Use the deadline on your denial notice; federal rules give at least 180 days. 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 Kentucky?

External Review. Send a written request to your insurer (the instructions are in your internal appeal decision letter). Include a signed consent letting the independent review entity get your medical records, and, if someone files for you, a written authorization.

Is outside review free in Kentucky?

You pay a one-time $25 filing fee to the independent review entity. It is waived for financial hardship (for example income below 200% of the federal poverty level, or getting Medicaid, K-TAP, unemployment insurance or a drug patient-assistance program) and refunded if you win.

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

30 days. The date of the notice.

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

Eligibility: if your hearing request about ending your Medicaid or raising your patient liability is received within 10 days of the advance notice, your coverage stays the same through the month of the final order; with good cause, a request within 20 days gets coverage reinstated. Covered services (not managed care): if your request is postmarked or received within 10 days of the advance notice date, you keep the service until the final order (not for time-limited benefits or if the only issue is a change in law).

How do I appeal a Marketplace decision in Kentucky?

Ask for an appeal by phone, by mail, in person or online. kynect first does a desk review (informal resolution) within 15 calendar days (3 business days if expedited). If you are not satisfied, your appeal goes to the Cabinet's Division of Administrative Hearings for a hearing before an impartial hearing officer.

Not about a denied claim?

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Sources

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