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

In North Dakota, your health plan is regulated by North Dakota Insurance Department, if it is a state-regulated plan.

North Dakota runs its own independent review of denials: External Review. 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.

North Dakota 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 North Dakota?

Appeal to your plan
At least 180 days from receipt of the denial (federal rule)
Outside review
4 months (federal rule)
Hearing deadline
30 days
Appeal to the plan first
60 days (federal rule)
Then a state hearing
120 days
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

If your plan is self-funded by a private employer or union, the U.S. Department of Labor regulates it and the state Insurance Department cannot investigate complaints about it. Some government, church, school district and out-of-state Blue Cross plans are also exempt from most state rules.

Step 1: Appeal to your plan in North Dakota

What it is called: Internal appeal (internal claims and appeals process / grievance)

North Dakota requires insurers, nonprofit health service corporations and HMOs to follow the federal internal claims and appeals rules. Contact your insurer or check your plan benefit packet for how to file an internal appeal.

Law: N.D.C.C. 26.1-36-47

All the details →

Step 2: Outside review in North Dakota

External Review

Deadline to ask: 4 months (federal rule).

All the details →

Urgent care in North Dakota: faster decisions

Outside review

Expedited review is for a denial about an admission, continued stay or service after emergency care when you have not been discharged, or a condition where standard timeframes would seriously jeopardize your life or health or your ability to regain maximum function.

Law: N.D.C.C. 26.1-36-46; N.D.C.C. 26.1-36-44 (grandfathered plans)

Complaints about your plan in North Dakota

If you cannot resolve a problem with your insurance company, you can file a complaint with the North Dakota Insurance Department using the online Consumer Complaint form, or ask the Department for a paper form. Describe what happened and what you want the company to do, and attach copies (not originals) of letters, the relevant part of your policy or benefits handbook, and other documents.

sbs.naic.org

Medicaid (North Dakota Medicaid (including Medicaid Expansion)) denials in North Dakota

Who holds the hearing: North Dakota HHS, Appeals Supervisor, Legal Advisory Unit.

Hearing deadline: 30 days

All the details →

Marketplace decisions in North Dakota

North Dakota uses HealthCare.gov. Appeals go to the federal Marketplace Appeals Center.

HealthCare.gov

1-855-231-1751

Other rights in North Dakota

Medicaid denials tied to disability status

If Medicaid was denied, reduced or ended because Social Security or the state review team denied or ended your disability status, you can ask for a fair hearing within 6 months after official notice from Social Security that your disability status was approved or reversed.

Law: N.D. Admin. Code 75-01-03-06(3)

Prior authorization time limits and reviewers (from January 1, 2026)

A plan or its prior authorization reviewer must decide a non-urgent prior authorization request within 7 calendar days, and an urgent one within 72 hours, after it has all the information it needs. A denial must be made by a licensed physician or pharmacist, and an appeal must be reviewed by a physician in the same or a similar specialty who was not involved in the denial. If the reviewer misses these deadlines, the care is treated as authorized. You can keep coverage while the appeal is pending.

Law: N.D.C.C. 26.1-36.12-03 to 26.1-36.12-06, 26.1-36.12-13, 26.1-36.12-14 (S.B. 2280, 2025, eff. January 1, 2026)

How long do I have? Deadline calculator

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

Good to know in North Dakota

  • North Dakota gives only 30 days from the date the notice was mailed to ask for a Medicaid fair hearing, shorter than the federal maximum of 90 days.

    Law: N.D. Admin. Code 75-01-03-06

  • Insurers in North Dakota may charge up to $25 to file an external review, refunded if you win and waived for hardship, with a $75 yearly cap.

    Law: N.D.C.C. 26.1-36-46(3)(d)

  • After a Medicaid managed care plan upholds a denial, North Dakota gives 120 days from the plan's notice to ask for a fair hearing.

    Law: N.D. Admin. Code 75-01-03-06(4)

Changes in 2024–2026

January 1, 2026: S.B. 2280 (2025) created N.D.C.C. chapter 26.1-36.12 on prior authorization: 7 calendar days for non-urgent and 72 hours for urgent requests, physician or pharmacist denials, physician appeal reviewers, and care deemed authorized if deadlines are missed.

Questions about appeals in North Dakota

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

North Dakota 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 North Dakota?

External Review. After you get the insurer's final decision on your internal appeal, file a request with your insurer or with the Insurance Commissioner. Once you are found eligible, the Department randomly assigns an IRO. You then have 5 business days to send the IRO more written information.

Is outside review free in North Dakota?

The insurer pays the reviewer. The insurer may charge you a filing fee of no more than $25, refunded if the denial is reversed, and waived if paying it would be an undue hardship.

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

30 days. The date the notice of action was mailed

Can I keep my Medicaid benefits while I appeal in North Dakota?

If you already get benefits and you ask for a fair hearing within the timely notice period (before the date the change takes effect; the notice must come at least 10 days before the change), your benefits continue unchanged until the hearing decision. If benefits were cut without timely notice, ask within 10 days.

Who regulates health insurance in North Dakota?

North Dakota Insurance Department. If your plan is self-funded by a private employer or union, the U.S. Department of Labor regulates it and the state Insurance Department cannot investigate complaints about it. Some government, church, school district and out-of-state Blue Cross plans are also exempt from most state rules.

Not about a denied claim?

Nearby states

Sources

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