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

In Missouri, your health plan is regulated by Missouri Department of Commerce and Insurance (DCI), Division of Consumer Affairs, if it is a state-regulated plan.

Missouri runs its own independent review of denials: External review by an Independent Review Organization (IRO), through the Department of Commerce and Insurance.

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.

MO HealthNet

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 Missouri?

Appeal to your plan
At least 180 days from receipt of the denial (federal rule)
Hearing deadline
90 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

External review through DCI is only for coverage bought as an insurance policy, not a self-funded plan sponsored by your employer. Your employer's Human Resources department can tell you whether the plan is self-funded.

Step 1: Appeal to your plan in Missouri

What it is called: Grievance (first-level and second-level review)

Group plans give you two chances to appeal to the insurance company (first-level and second-level grievances). Individual plans may have one or two levels; check your policy. For a managed care plan, the company must acknowledge a first-level grievance in writing within 10 working days and investigate within 20 working days (it can take up to 30 more working days if it tells you why in writing). Someone not involved in the case then decides, and the company must tell you the result within 15 working days after the investigation ends. A second-level grievance goes to a panel that includes other enrollees, and if it would uphold a medical denial, two independent clinical peers must review it. For urgent cases, you can ask for an expedited review orally or in writing; the company must tell you its decision within 72 hours and confirm it in writing within 3 working days.

Law: RSMo 376.1382, 376.1385, 376.1389

All the details →

Step 2: Outside review in Missouri

External review by an Independent Review Organization (IRO), through the Department of Commerce and Insurance

All the details →

Urgent care in Missouri: faster decisions

Appeal to your plan

  • Your plan must decide an urgent appeal within 72 hours.

Outside review

If your medical situation is urgent, contact DCI as soon as possible. The IRO responds within 72 hours after it receives all the medical information.

Law: RSMo 376.1387

Complaints about your plan in Missouri

Contact your insurance company first and keep notes of calls and copies of letters. If you are not satisfied, call the DCI Insurance Consumer Hotline at 800-726-7390 (8 a.m. to 5 p.m. weekdays), file a complaint online in English or Spanish, or mail it to P.O. Box 690, Jefferson City, MO 65102-0690. DCI forwards your complaint to the company and requires a response.

sbs.naic.org

Medicaid (MO HealthNet (Missouri Medicaid)) denials in Missouri

Who holds the hearing: Missouri Department of Social Services, Division of Legal Services, Administrative (Benefit) Hearings Unit.

Hearing deadline: 90 days

All the details →

Marketplace decisions in Missouri

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

HealthCare.gov

1-855-231-1751

Other rights in Missouri

No take-backs after approval

If your plan approves care in advance, it cannot later take back the approval or cut payment after the care is given, unless the approval was based on a material misrepresentation or omission about your health, or the plan or your coverage ended before the care was given.

Law: RSMo 376.1361(13)

Who reviews denials

A licensed clinical peer must evaluate the clinical appropriateness of a denial, and the medical director overseeing review decisions must be licensed in Missouri. Reviewers cannot be paid based on the number or type of denials.

Law: RSMo 376.1361(2), (9)

How long do I have? Deadline calculator

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

Good to know in Missouri

  • Missouri law sets no time limit to ask for external review, and you do not have to finish the plan's appeals first (Missouri DCI, Consumer Health Appeals and External Review).
  • In Missouri, you ask the Department of Commerce and Insurance for external review, and the Department first tries to resolve law or policy violations itself before sending a case to an independent reviewer.

    Law: RSMo 376.1387

  • To keep MO HealthNet benefits during a hearing you must ask within 10 days of the date on the Action Notice; you have 90 days to ask for a hearing without continued benefits (RSMo 208.080; DSS Hearings Information).

Questions about appeals in Missouri

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

Missouri law does not set a different 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 Missouri?

External review by an Independent Review Organization (IRO), through the Department of Commerce and Insurance. Contact DCI's Division of Consumer Affairs (800-726-7390, online complaint form, or mail to P.O. Box 690, Jefferson City, MO 65102-0690). DCI reviews the claim, gets the company's claim file and tells you and the company if the case is eligible.

Is outside review free in Missouri?

There is no charge to consumers for external review under Missouri law.

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

90 days. The date shown on your Action Notice

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

If you want your benefits to continue while your hearing is pending, you must request a hearing within 10 days from the date shown on the Action Notice. If you ask later (within the 90 days), benefits do not continue at their prior level while you wait.

Who regulates health insurance in Missouri?

Missouri Department of Commerce and Insurance (DCI), Division of Consumer Affairs. External review through DCI is only for coverage bought as an insurance policy, not a self-funded plan sponsored by your employer. Your employer's Human Resources department can tell you whether the plan is self-funded.

Not about a denied claim?

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