External review in Kentucky: deadline, cost and how to ask
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.
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 Kentucky
- Program
External Review
- Who runs it
- Independent review entity (IRE) certified by the Kentucky Department of Insurance and assigned to your insurer on a rotating basis: Insured plans regulated by the Department of Insurance: denials other than 'coverage denials'
- Kentucky Department of Insurance: Coverage denials (the plan says the service is excluded or not covered) and disputes about your right to external review
- Deadline to ask
60 days
Send your request for external review to your insurer within 60 days of receiving the internal appeal decision. If you give the insurer new clinical information before the external review starts, the 60 days do not start until the insurer decides on that information. If your denial notice gives you more time, follow the notice.
- The deadline runs from
The date you receive the notice that your internal appeal was denied
- Do I have to appeal to my plan first?
You must finish the insurer's internal appeal first, unless the insurer did not decide it on time or you and the insurer both agree to skip it.
- How long the review takes
Standard: 21 days; Urgent: 24 hours
- Cost
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. The insurer pays the cost of the review itself.
- What can be reviewed
Adverse benefit determinations other than coverage denials, for example denials as not medically necessary or as experimental or investigational, and step therapy exception denials. The whole course of treatment must cost at least $100 if you had no insurance, and you must have been covered when the service was given or requested. 'Coverage denials' (the policy excludes or limits the service) go to the Department of Insurance for review instead.
- Is the decision final?
The independent review entity's decision is binding on the insurer for you. If the insurer does not provide the coverage, it must pay the claim and can be penalized by the Department of Insurance.
- How to ask
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. If you and the insurer disagree about whether you can have an external review, you can file a complaint with the Department of Insurance, which decides within 5 days.
Law: KRS 304.17A-619(1), 304.17A-623, 304.17A-625(9)-(10); KRS 806 KAR 17:290
- Phone
Write my appeal: free letters
Sources
The official sources for Kentucky are listed on the Kentucky page.