External review in North Dakota: deadline, cost and how to ask
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.
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 North Dakota
- Program
External Review
- Who runs it
- North Dakota Insurance Department, which randomly assigns an independent review organization (IRO) under contract: Non-grandfathered plans (issued March 23, 2010 or later) from insurance companies, nonprofit health service corporations and HMOs
- North Dakota Health Care Review, Inc., another qualified peer review organization, or a person the Commissioner names: Grandfathered plans (issued before March 23, 2010)
- Deadline to ask
Federal rule: at least 4 months.
You have up to 4 months after you receive the denial notice to ask for external review, unless your insurer allows longer. For grandfathered plans, the insurer may set its own deadline.
- The deadline runs from
The date you receive the notice of the adverse benefit determination
- Do I have to appeal to my plan first?
In most cases you must finish the insurer's internal appeal first. You do not have to if the insurer waives it, if you are treated as having finished it under the law, or if you file for expedited external review (you can do that while an internal appeal is still being processed).
- Cost
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. Fees cannot exceed $75 in one plan year. For grandfathered plans, if the reviewer upholds the denial, you may have to pay the costs.
- What can be reviewed
Denials involving medical necessity, appropriateness, health care setting, level of care or effectiveness of a covered benefit; treatments found experimental or investigational; and cancellation of coverage with retroactive effect (rescission). Denials about whether you are eligible for benefits under the terms of coverage are not included. There is no minimum dollar amount.
- Is the decision final?
The decision is binding on you and the insurer, except where other remedies are available under state or federal law. The insurer must pay or provide benefits without delay, even if it plans to go to court.
- How to ask
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.
Law: N.D.C.C. 26.1-36-46; N.D.C.C. 26.1-36-44 (grandfathered plans)
- Forms and online request
- Phone
701-328-2440 or 1-800-247-0560
Write my appeal: free letters
Sources
The official sources for North Dakota are listed on the North Dakota page.