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

In Ohio, your health plan is regulated by Ohio Department of Insurance (ODI), if it is a state-regulated plan.

Ohio runs its own independent review of denials: External Review. You generally have 180 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.

Ohio 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 Ohio?

Appeal to your plan
At least 180 days from receipt of the denial (federal rule)
Outside review
180 days
Hearing deadline
90 days
Appeal to the plan first
60 days (federal rule)
Then a state hearing
90 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 you bought insurance yourself or get it from an employer that does business only in Ohio, contact the Ohio Department of Insurance. If your coverage is through a self-insured employer (usually a large company or one with locations in several states), contact the U.S. Department of Labor, EBSA.

Step 1: Appeal to your plan in Ohio

What it is called: Internal appeal

Every health plan issuer must have an internal appeal process that follows federal law. Plans sold to individuals may not require more than one level of internal appeal before you can ask for external review. Your plan's denial notice must tell you how to appeal, the denial codes and their meaning, and that the Department of Insurance can help you.

Law: Ohio Rev. Code 3922.03, 3922.04(F), 3922.19(C)

All the details →

Step 2: Outside review in Ohio

External Review

Deadline to ask: 180 days.

All the details →

Urgent care in Ohio: faster decisions

Outside review

You can ask for expedited review if your treating doctor certifies that waiting could seriously jeopardize your life, health or ability to regain maximum function, or if the denial concerns emergency care and you have not yet been discharged. The IRO decides within 72 hours of when the plan receives the request. Expedited review is not available for claims for care already received.

Law: Ohio Rev. Code 3922.02, 3922.04, 3922.05, 3922.09-3922.12, 3922.18

Standard: 30 days

Complaints about your plan in Ohio

For other problems with your insurer or HMO, contact the Department of Insurance Consumer Services at 1-800-686-1526 or use the online contact form.

Law: Ohio Rev. Code 3922.19(C)(2)(e)

insurance.ohio.gov

Medicaid (Ohio Medicaid) denials in Ohio

Who holds the hearing: Ohio Department of Job and Family Services (ODJFS), Bureau of State Hearings.

Hearing deadline: 90 days

All the details →

Marketplace decisions in Ohio

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

HealthCare.gov

1-855-231-1751

Other rights in Ohio

How fast a plan must answer a prior approval and an appeal of it

Insurers and plans must answer prior authorization requests within 48 hours for urgent care and within 10 calendar days for other care. If they deny one, the doctor can use a streamlined appeal with a clinical peer, decided within 48 hours for urgent care and 10 calendar days for other care.

Law: Ohio Rev. Code 3923.041(B)(4), (B)(12)

Coverage disputes reviewed by the Department

If your plan says a service is not covered under your contract (with no medical judgment involved), the Department of Insurance itself decides whether it is covered. If it says yes, the plan must cover it; if it finds a medical question, the plan must send the case to an IRO.

Law: Ohio Rev. Code 3922.11

How long do I have? Deadline calculator

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

Good to know in Ohio

  • Ohio gives 180 days to ask for external review, longer than the federal minimum of 4 months.

    Law: Ohio Rev. Code 3922.02(B)

  • In Ohio you send your external review request to your health plan, not to the Department of Insurance; the Department then randomly assigns the reviewer.

    Law: Ohio Rev. Code 3922.02, 3922.05(F)

  • Ohio Medicaid managed care plans must decide standard appeals within 15 calendar days, faster than the federal 30 days.

    Law: Ohio Admin. Code 5160-26-08.4

Changes in 2024–2026

April 3, 2025: Ohio's rule on continuing benefits while a state hearing is pending was re-adopted. Ohio's Medicaid work and community engagement requirement takes effect January 1, 2027 (Ohio Department of Medicaid, Group VIII partner packet, August 2026).

Law: Ohio Admin. Code 5101:6-4-01

Questions about appeals in Ohio

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

State law follows the federal internal appeal rules. Use the deadline on your denial notice; federal rules give at least 180 days. 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 Ohio?

External Review. Send your written request to your health plan (not to the Department). The plan checks that the request is complete and starts the review; the Department's system then randomly assigns an IRO. You have 10 business days after the plan's notice that your request is complete to send more information to the IRO or the Department.

Is outside review free in Ohio?

The health plan issuer pays the cost of the external review.

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

90 days. The day after the notice was mailed (the 90 days start the day after the mailing date; the request counts as made on the date State Hearings or the county agency receives it)

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

Ohio gives 15 calendar days of advance notice before reducing, suspending or ending benefits. If State Hearings, your county agency or your managed care plan receives your hearing request within that 15-day notice period, your benefits stay the same until the hearing decision.

Who regulates health insurance in Ohio?

Ohio Department of Insurance (ODI). If you bought insurance yourself or get it from an employer that does business only in Ohio, contact the Ohio Department of Insurance. If your coverage is through a self-insured employer (usually a large company or one with locations in several states), contact the U.S. Department of Labor, EBSA.

Not about a denied claim?

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