Health insurance or Medicaid said no in Louisiana? Deadlines and free help
In Louisiana, your health plan is regulated by Louisiana Department of Insurance (LDI), if it is a state-regulated plan.
Louisiana runs its own independent review of denials: External Review (Louisiana Health Plan Independent 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.
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.
Louisiana 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.
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 Louisiana?
- Appeal to your plan
- At least 180 days from receipt of the denial (federal rule)
- Outside review
- 4 months
- Hearing deadline
- 30 days
- Appeal to the plan first
- 60 days (federal rule)
- Then a state hearing
- 120 days
- Appeal deadline – HealthCare.gov
- 90 days (federal rule)
How do I know which plan type I have?
- Louisiana Department of Insurance (LDI) · 800-259-5300; local 225-342-5900
Health insurance issuers (insurance companies and HMOs) selling individual plans and fully-insured employer plans in Louisiana. The Commissioner of Insurance assigns the independent reviewer for external reviews.
How to tell which agency regulates your plan
Contact the Louisiana Department of Insurance if you bought insurance yourself or have insurance from an employer that does business only in Louisiana. If your coverage is through a self-insured employer (often a large company or one with locations in several states), contact the U.S. Department of Labor's Employee Benefits Security Administration.
Step 1: Appeal to your plan in Louisiana
What it is called: Internal claims appeal (grievance)
Your insurer must have an internal appeal process that follows federal law. It must tell you about the internal and external appeal processes and that the Department of Insurance's Office of Consumer Advocacy can help you with an appeal. You can see and get free copies of all documents relevant to your claim and send comments and documents. If the insurer has not given you a written decision on your grievance within 30 days of filing it (and you did not agree to a delay), you can go to external review.
Law: La. R.S. 22:2401, 22:2435(A)(2)
Step 2: Outside review in Louisiana
External Review (Louisiana Health Plan Independent Review)
Deadline to ask: 4 months.
Urgent care in Louisiana: faster decisions
Outside review
You can ask for an expedited external review when the normal time frame would seriously jeopardize your life or health or your ability to regain maximum function, when the denial concerns an admission, availability of care, a continued stay or emergency services and you have not been discharged, or for experimental treatment when your doctor certifies that delay poses an imminent threat to your health. The reviewer decides as fast as your condition requires, and no more than 72 hours after the insurer receives the request.
Law: La. R.S. 22:2433-22:2439, 22:2444
Medicaid
Check "Yes" for an expedited fair hearing on the appeal form if you have an emergency health issue. LDH may contact you for proof of the emergency.
Law: LAC 50:III.101
Complaints about your plan in Louisiana
For other problems with your insurer, contact the Louisiana Department of Insurance at 800-259-5300 (local 225-342-5900), 1702 N. Third Street, Baton Rouge, LA 70802; mailing address P.O. Box 94214, Baton Rouge, LA 70804. The Department's Office of Consumer Advocacy can help with appeals.
Law: La. R.S. 22:2401(2)
Medicaid (Louisiana Medicaid (Healthy Louisiana for managed care)) denials in Louisiana
Who holds the hearing: Louisiana Division of Administrative Law (DAL), Health and Hospitals Section.
Hearing deadline: 30 days
Marketplace decisions in Louisiana
Louisiana uses HealthCare.gov. Appeals go to the federal Marketplace Appeals Center.
Other rights in Louisiana
If the insurer says your request is not eligible
In Louisiana the insurance company does the first eligibility check of your external review request. If it says your request is not eligible, you can ask the Commissioner of Insurance in writing to decide. The Commissioner can order the case sent to an independent reviewer and must answer within 5 business days.
Law: La. R.S. 22:2436(C)(3)-(4)
How long do I have? Deadline calculator
Pick your plan type and enter the dates on your notice. We count from the rules in Louisiana and the federal rules.
Write my appeal: free letters
Free help in Louisiana
- Louisiana Department of Insurance · 800-259-5300
Listed by HHS as Louisiana's resource for questions about insurance you bought yourself or through an employer that does business only in Louisiana. - Louisiana Medicaid (Louisiana Department of Health) · 1-888-342-6207
Listed by HHS for questions about Medicaid eligibility and benefits. - Southeast Louisiana Legal Services
- CMS help page for this state
- LawHelp.org
- Your state's Consumer Assistance Program (CAP) or insurance department
- U.S. Department of Labor, Employee Benefits Security Administration (EBSA) · 1-866-444-3272
- HealthCare.gov Marketplace Call Center and local help · 1-800-318-2596
- CCIIO Health Insurance Assistance Team · 1-888-393-2789
- Legal Services Corporation (LSC) - Find legal aid
Good to know in Louisiana
- Louisiana Medicaid gives 30 days from the date of the decision notice to ask for a fair hearing, shorter than the federal maximum of 90 days (LAC 50:III.101(C)).
- In Louisiana you send an external review request to your insurer, not to the state; LDI then assigns the reviewer at random.
Law: La. R.S. 22:2434(A), 22:2436(D)
- Louisiana's Medicaid work/community engagement requirements start on January 1, 2027, for renewals and new applications (LDH, Medicaid Work Requirements).
Changes in 2024–2026
Louisiana Medicaid work/community engagement requirements begin January 1, 2027, for members up for renewal and new applicants; members renewing in January 2027 got a notice in May 2026 and renewal packets in November 2026. From January 1, 2027, most adults 19-64 have one month of possible retroactive coverage (LDH, Medicaid Work Requirements). Act 2022, No. 81 (eff. January 1, 2023) changed how insurers request reviewer assignment through LDI's website. SB 246 of the 2026 Regular Session (AI and automated decision systems in utilization review) was withdrawn on May 28, 2026 and did not become law.
Law: La. R.S. 22:2436-2437
Questions about appeals in Louisiana
How long do I have to appeal a health insurance denial in Louisiana?
Louisiana law follows the federal rules. 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 Louisiana?
External Review (Louisiana Health Plan Independent Review). Send your request in writing to your insurance company, at the address in its denial notice (expedited requests do not have to be in writing). Include the forms in the notice, including the signed authorization to release your medical records.
Is outside review free in Louisiana?
The insurer pays the cost of the external review. No fee or other charge may be charged to you.
How long do I have to ask for a Medicaid fair hearing in Louisiana?
30 days. The date of the decision notice issued by Medicaid or its designee
Can I keep my Medicaid benefits while I appeal in Louisiana?
If you ask for a hearing before the date of action on your notice, your services are not cut or stopped until the hearing decision, unless the only issue is a federal or state law or policy. LDH also tells members that appealing within 10 days of the denial keeps current services from being stopped while the appeal is reviewed.
Who regulates health insurance in Louisiana?
Louisiana Department of Insurance (LDI). Contact the Louisiana Department of Insurance if you bought insurance yourself or have insurance from an employer that does business only in Louisiana. If your coverage is through a self-insured employer (often a large company or one with locations in several states), contact the U.S. Department of Labor's Employee Benefits Security Administration.
Not about a denied claim?
Nearby states
Sources
- La. R.S. 22:2401 (Louisiana State Legislature)
- La. R.S. 22:2433-2437, 2439, 2444 (Louisiana State Legislature)
- La. R.S. 22:2444 Funding of external review
- Louisiana Administrative Code Title 50 (LAC 50:III.101; 50:I.3705-3715), Office of the State Register, Word file
- LDH, How to Appeal Medicaid
- LDH, Appeal brochure and form (Appendix L, 11/2023)
- Louisiana Division of Administrative Law, Health
- LDH, Medicaid Work Requirements
- CMS CCIIO, Louisiana Consumer Assistance