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

In Montana, your health plan is regulated by Montana Commissioner of Securities and Insurance (CSI), Office of the Montana State Auditor, if it is a state-regulated plan.

Montana runs its own independent review of denials: External Review. You generally have 120 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.

Montana 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.

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 Montana?

Appeal to your plan
At least 180 days from receipt of the denial (federal rule)
Outside review
120 days
Hearing deadline
90 days
Appeal deadline – HealthCare.gov
90 days (federal rule)

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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 Montana, contact the CSI. If your job-based coverage is from 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 Montana

What it is called: Grievance (internal grievance review)

Montana law follows the federal timelines: the insurer must decide within 30 days for care you have not received yet, 60 days for care already received, and 72 hours for an expedited review. Your insurer's grievance papers must tell you that you can contact the Commissioner's office for help at any time, with its phone number and address.

Law: Mont. Code Ann. 33-32-307, 33-32-308(1), 33-32-309(6)

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Step 2: Outside review in Montana

External Review

Deadline to ask: 120 days.

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Urgent care in Montana: faster decisions

Outside review

You can ask for expedited external review if the normal time could seriously jeopardize your life or health or your ability to regain maximum function, or if the denial concerns an admission, continued stay or service after emergency care and you have not been discharged. The reviewer must decide as fast as your condition requires and no later than 72 hours after receiving the request. Expedited review is not available for care you already received.

Law: Mont. Code Ann. 33-32-404, 33-32-405, 33-32-410, 33-32-411, 33-32-412, 33-32-415, 33-32-422

Medicaid

The state manual offers an expedited hearing to households that will leave Montana before a decision would normally be made. No separate health-urgency rule is stated in the manual; federal rules require an expedited hearing when the normal timeline could seriously jeopardize your life, health or ability to regain maximum function.

Law: ARM 37.5.307

Complaints about your plan in Montana

You can file a complaint with the CSI online or with the paper complaint form by mail, email or fax (Montana Insurance Department, Attn: ICS, 840 Helena Avenue, Helena, Montana 59601). Complaints must be in writing. CSI consumer advocates answer general questions at 1-800-332-6148 or 406-444-2040.

sbs.naic.org

Medicaid (Montana Medicaid (and Healthy Montana Kids Plus)) denials in Montana

Who holds the hearing: DPHHS Office of Administrative Hearings (formerly Office of Fair Hearings).

Hearing deadline: 90 days

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Marketplace decisions in Montana

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

HealthCare.gov

1-855-231-1751

Other rights in Montana

If the insurer does not send your file on time

If your insurer does not send the reviewer your records within 5 business days after the reviewer is assigned, the reviewer may end the review and reverse the denial.

Law: Mont. Code Ann. 33-32-410(10), (12)

How long do I have? Deadline calculator

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

Good to know in Montana

  • Montana gives 120 days (not 4 months) to ask for external review.

    Law: Mont. Code Ann. 33-32-410(1)

  • In a Montana Medicaid hearing, after the hearing officer's decision you can appeal to the Board of Public Assistance within 15 days of the date the decision notice is mailed.
  • Montana began Medicaid Expansion community engagement requirements on July 1, 2026, before the federal January 1, 2027 start (DPHHS news release, June 2026).

Changes in 2024–2026

Montana started Medicaid Expansion community engagement (work) requirements early, on July 1, 2026: most Expansion members ages 19 to 64 who are not excluded must complete and document at least 80 hours of qualifying activities each month, reviewed at their next renewal. This follows the Legislature's reauthorization of Medicaid Expansion and federal law. (DPHHS news release, June 30, 2026). Under federal law, you must get a written notice and the right to a fair hearing before coverage is denied or ended.

Law: H.R. 1, July 4, 2025; Pub. L. 119-21

Questions about appeals in Montana

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

You have 180 days after you receive the denial notice to file a grievance with your insurer. This is the same as the federal rule. 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 Montana?

External Review. Send a written request to your insurer (an expedited request can be made by phone). The insurer checks within 5 business days that the request is complete and eligible, then assigns an approved independent review organization.

Is outside review free in Montana?

Your insurer pays the cost of the independent review organization. Montana law does not charge you a fee.

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

90 days. The date the notice of the action is mailed (the department must receive your written request within 90 days)

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

Your benefits continue at the same level until the hearing decision if you file your hearing request between the date the notice is mailed and the date the action takes effect, unless you say you do not want them continued. If the state did not send timely advance notice, benefits continue if you ask within 10 days of receiving the notice.

Who regulates health insurance in Montana?

Montana Commissioner of Securities and Insurance (CSI), Office of the Montana State Auditor. If you bought insurance yourself or get it from an employer that does business only in Montana, contact the CSI. If your job-based coverage is from 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.

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