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

In Nevada, state-regulated health plans are overseen by Nevada Division of Insurance and Office for Consumer Health Assistance (OCHA), Aging and Disability Services Division.

Nevada runs its own independent review of denials: External Review (Office for Consumer Health Assistance). 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.

Nevada Medicaid

You ask the state for a fair hearing. In a Medicaid health plan, you usually appeal to the plan first.

Marketplace (Nevada Health Link (Silver State Health Insurance Exchange)) 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 Nevada?

Appeal to your plan
At least 180 days from receipt of the denial (federal rule)
Outside review
4 months (federal rule)
Hearing deadline
90 days
Appeal to the plan first
60 days (federal rule)
Then a state hearing
90 days
Appeal deadline – Nevada Health Link (Silver State Health Insurance Exchange)
90 days

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

Every denial notice from a Nevada-regulated plan must list the phone number of the Office for Consumer Health Assistance and explain your right to file a written complaint and ask for external review. If your coverage is self-funded by your employer, it may follow a different review process; the OCHA request form asks you to check this with your employer.

Law: NRS 695G.230(3); OCHA External Review Request Form OCHA-EI-02 (06.16.2025)

Step 1: Appeal to your plan in Nevada

What it is called: Complaint (grievance) and appeal to the plan's review board

An HMO or managed care plan must review your written complaint or appeal and tell you its decision within 30 days, unless you agree to a longer time. If the complaint involves an imminent and serious threat to your health, the plan must tell you right away about expedited review and send a written decision within 72 hours. The plan must, on request, assign an employee to help you file, and you can appear before the review board and bring documents (send them at least 5 business days before the hearing). If you complain by phone, you must put it in writing to get further review.

Law: NRS 695G.200, 695G.210

All the details →

Step 2: Outside review in Nevada

External Review (Office for Consumer Health Assistance)

Deadline to ask: 4 months (federal rule).

All the details →

Urgent care in Nevada: faster decisions

Appeal to your plan

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

Outside review

If your provider sends proof that waiting could put your life, health or ability to regain maximum function at risk, or you received emergency care and have not left the facility, OCHA decides within 72 hours whether to approve expedited review, and the reviewer must finish within 48 hours after the case is assigned. For experimental or investigational treatment, you can ask by phone for expedited review if your doctor certifies in writing that the treatment would be significantly less effective if not started promptly.

Law: NRS 695G.241-695G.310 (esp. 695G.245, 695G.247, 695G.251, 695G.261, 695G.271, 695G.275, 695G.290)

Standard: 15 days; Urgent: 48 hours

Medicaid

Check the expedited box on the request form and attach your provider's medical documentation showing that a standard hearing could jeopardize your life, health or ability to attain, maintain or regain maximum function. Expedited hearings are by phone, and the decision is due no later than 3 working days after the Hearings Office receives the request.

Law: NRS 422.306

Marketplace

You can ask for an expedited appeal if a standard appeal could jeopardize your life, health, or ability to attain, maintain or regain maximum function. Explain how in the appeal request.

Complaints about your plan in Nevada

If you cannot resolve a problem with your insurance company, you can file a complaint with the Division of Insurance online or by mailing the complaint form to a Division office. An investigator is assigned, and the company generally must answer within 20 business days. Filing a complaint does not extend any deadline in your policy or the law.

gov.sircon.com

Medicaid (Nevada Medicaid) denials in Nevada

Who holds the hearing: Nevada Medicaid Hearings Unit with a Department of Administration hearing officer (service denials); DSS Administrative Adjudications Unit (eligibility).

Hearing deadline: 90 days

All the details →

Marketplace decisions in Nevada

Marketplace

Nevada Health Link (Silver State Health Insurance Exchange) · 1-800-547-2927

Appeal deadline

90 days

The date on your Eligibility Notice (the postmark date or the date your email is received counts as the filing date)

How to appeal

File online on the Nevada Health Link appeals page, by phone at 1-800-547-2927 (TTY 711), or by mailing the Nevada Health Link Appeal Request Form to Nevada Health Link, Attn: Appeals, 2310 S. Carson St. Suite 2, Carson City, NV 89701. Nevada Health Link first tries an informal resolution; if you are not satisfied, tell it within 10 days of that decision to schedule a hearing.

Form

Nevada Health Link Appeal Request Form

Faster appeal

You can ask for an expedited appeal if a standard appeal could jeopardize your life, health, or ability to attain, maintain or regain maximum function. Explain how in the appeal request.

Other rights in Nevada

What a denial notice must tell you

When a Nevada plan denies coverage, it must notify you in writing within 21 days (electronic claims) or 30 days (paper claims) after it has all the information, or within 10 working days if no claim was filed. The notice must give all the reasons, the plan provisions and the criteria used and how they were applied, your right to file a complaint and ask for external and expedited external review, your right to help from anyone including a lawyer, and OCHA's phone number.

Law: NRS 695G.230(2)-(3)

How long do I have? Deadline calculator

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

Good to know in Nevada

  • In Nevada, external review requests go to the Office for Consumer Health Assistance, not to your insurer.

    Law: NRS 695G.247, 695G.251

  • Nevada's independent reviewer must decide a standard external review within 15 days after receiving the information it needs, faster than the federal 45 days.

    Law: NRS 695G.261

  • Nevada Health Link eligibility appeals are heard by hearing officers of the Nevada Division of Social Services (Nevada Health Link Appeal Request Form; DSS Administrative Adjudications Unit).

Changes in 2024–2026

2025: AB 36 (83rd Session) amended NRS 422.306; Nevada Medicaid added a list of extenuating circumstances that can justify a provider's fair hearing request after 90 days. 2025 amendments also changed NRS 695G.230, 695G.243, 695G.245, 695G.251, 695G.261, 695G.271 and 695G.280. Nevada Medicaid is now run by the Nevada Health Authority (nvha.nv.gov). Nevada Medicaid has a work, school and volunteer requirements page for expansion adults ages 19-64 under the new federal law.

Questions about appeals in Nevada

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

Nevada 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 Nevada?

External Review (Office for Consumer Health Assistance). Fill out the OCHA External Review Request Form, sign the medical records release, and send it to OCHA by mail, fax or email. Attach a copy of your insurance card and the plan's letter saying its decision is final (or that the internal review was waived).

Is outside review free in Nevada?

Free to you. The health carrier that made the denial pays the cost of the external review.

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

90 days. The date on the Notice of Decision

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

To keep your services the same until the hearing decision, ask for a hearing before the Date of Action on your notice and check the box to continue services. If you ask no more than 10 calendar days after the Date of Action, Nevada Medicaid may reinstate your services; it must reinstate them if it did not send the required advance notice.

How do I appeal a Marketplace decision in Nevada?

File online on the Nevada Health Link appeals page, by phone at 1-800-547-2927 (TTY 711), or by mailing the Nevada Health Link Appeal Request Form to Nevada Health Link, Attn: Appeals, 2310 S. Carson St. Suite 2, Carson City, NV 89701. Nevada Health Link first tries an informal resolution; if you are not satisfied, tell it within 10 days of that decision to schedule a hearing.

Not about a denied claim?

Nearby states

Sources

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