External review in Ohio: deadline, cost and how to ask
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.
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 Ohio
- Program
External Review
- Who runs it
- Independent review organization (IRO) randomly assigned by the Ohio Department of Insurance: Denials that involve a medical judgment or medical information, including experimental or investigational treatment
- Ohio Department of Insurance (Superintendent of Insurance): Denials based on a contract issue with no medical judgment (whether the service is covered at all), and emergency-care denials already upheld by an IRO (reviewed under the prudent layperson standard)
- Deadline to ask
180 days
You must ask for external review in writing (or by email) within 180 days of the date of the final denial notice. An expedited request can be made by phone.
- The deadline runs from
The date of the notice of final adverse benefit determination (the final denial after the internal appeal)
- Do I have to appeal to my plan first?
You must usually finish the plan's internal appeal first. You can go to external review sooner if the plan has not decided your appeal within 30 days (and you did not agree to a delay), if the plan broke the internal appeal rules, or if the plan agrees to waive the internal appeal. In urgent cases you can ask for expedited external review at the same time as an expedited internal appeal.
- When you can go without a plan answer
30 days after you file your internal appeal
- How long the review takes
Standard: 30 days
- Cost
The health plan issuer pays the cost of the external review.
- What can be reviewed
Any adverse benefit determination, whatever the cost of the service: denials based on medical necessity, appropriateness, health care setting, level of care or effectiveness, experimental or investigational treatment (unless the service is explicitly excluded by your plan), rescission of coverage, and contract or coverage disputes (decided by the Department of Insurance).
- Is the decision final?
The decision is binding on the plan and on you, except for other remedies under state or federal law. You cannot ask for another external review of the same denial unless you give the plan new medical or scientific evidence.
- How to ask
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. If the plan says your denial is not eligible, you can appeal that to the Department of Insurance.
Law: Ohio Rev. Code 3922.02, 3922.04, 3922.05, 3922.09-3922.12, 3922.18
- Forms and online request
- Phone
Write my appeal: free letters
Sources
The official sources for Ohio are listed on the Ohio page.