External review in Missouri: deadline, cost and how to ask
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.
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 Missouri
- Program
External review by an Independent Review Organization (IRO), through the Department of Commerce and Insurance
- Who runs it
- Missouri Department of Commerce and Insurance, Division of Consumer Affairs, which refers eligible cases to a contracted IRO (CIMRO, Maximus Federal Services, or Kansas Foundation for Medical Care): Insured health plans regulated by DCI (not self-funded employer plans)
- Deadline to ask
Missouri law does not currently set a time limit to ask DCI for external review. DCI asks you to contact it as soon as possible.
- The deadline runs from
Not set by Missouri law
- Do I have to appeal to my plan first?
DCI suggests you use all of your plan's appeal and grievance options first, but you are not required to finish them before asking for external review.
- Cost
There is no charge to consumers for external review under Missouri law.
- What can be reviewed
Denials because the insurer says treatment is not medically necessary, is experimental, is not as effective as other treatment, or that you need a different or lesser level of care. This can include hospital stays, surgery, mental health and substance use treatment, physical therapy, outpatient services, pharmacy and cancer treatment. Not eligible: workers' compensation, auto medical payment or liability claims, long-term care and disability income. If the problem is a violation of Missouri insurance law or a policy provision, DCI tries to resolve it directly instead of sending it to an IRO.
- Is the decision final?
The decision is binding on you and the insurance company, with limited exceptions for court review. A court case to review the decision must be filed within 30 days of the final agency decision.
- How to ask
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. Both of you then have 15 working days to send more medical information for the reviewer.
Law: RSMo 376.1387
- Forms and online request
- Phone
Write my appeal: free letters
Sources
The official sources for Missouri are listed on the Missouri page.