External review in New York: deadline, cost and how to ask
New York runs its own independent review of denials: New York State External Appeal. 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.
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 New York
- Program
New York State External Appeal
- Who runs it
- New York State Department of Financial Services (DFS), which assigns a certified external appeal agent: Insured health plans and HMOs regulated in New York, including Medicaid managed care, Essential Plan and Child Health Plus plans
- Deadline to ask
4 months
You have 4 months to apply. If your plan offers a second-level internal appeal, you do not have to use it; if you do, the 4 months still run from the first appeal decision. If DFS does not receive your application within 4 months, you cannot get an external appeal. A provider appealing on its own behalf has 60 days.
- The deadline runs from
The date you receive the plan's final adverse determination (or the date you and the plan agreed to skip the internal appeal)
- Do I have to appeal to my plan first?
You must first get the plan's final adverse determination from an internal appeal. You can skip it if you and the plan both agree to waive the internal appeal, or if federal rules treat the internal appeal as finished (for example, the plan did not follow the rules). You can ask for an expedited internal and an expedited external appeal at the same time.
- How long the review takes
Standard: 30 days
- Cost
Your plan may charge up to $25 per external appeal, but not more than $75 in one plan year. There is no fee if you have Medicaid or Child Health Plus, or if the fee would be a hardship. The fee is refunded if the denial is overturned.
- What can be reviewed
Denials because a service is not medically necessary; denials as experimental or investigational (including clinical trials and rare disease treatment, with a doctor's certification); out-of-network service denials when the plan offers an in-network alternative; out-of-network referral denials; and No Surprises Act issues such as whether emergency care or a surprise bill was handled correctly.
- Is the decision final?
The external appeal agent's decision is binding on you and your plan. If you have Medicaid and ask for both a fair hearing and an external appeal, the fair hearing decision is the final decision about your benefits.
- How to ask
Apply online through the DFS Portal (choose "DFS Portal Login"), or complete the fillable New York State External Appeal Application and send it by email to earesponse@dfs.ny.gov, by fax to 1-800-332-2729, or by certified or registered mail to the Department of Financial Services, 99 Washington Avenue, Box 177, Albany, NY 12210. Attach the patient consent form (actual signature needed) and, for some appeal types, a physician attestation form. If you fax an expedited appeal, call 1-888-990-3991.
Law: N.Y. Ins. Law 4910, 4914
- Forms and online request
- Phone
Write my appeal: free letters
Sources
The official sources for New York are listed on the New York page.