External review in Oregon: deadline, cost and how to ask
Oregon runs its own independent review of denials: External Review (independent review organization). 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 Oregon
- Program
External Review (independent review organization)
- Who runs it
- Oregon Division of Financial Regulation, which assigns an independent review organization under contract with the state: Insured health benefit plans regulated in Oregon
- Deadline to ask
180 days
Apply in writing within 180 calendar days after you receive the insurer's final written decision. Requests after 180 days do not qualify.
- The deadline runs from
The date you receive the insurer's final written decision after its internal appeal (final adverse benefit determination letter)
- Do I have to appeal to my plan first?
You must finish all levels of internal appeal first, unless you and the insurer agree to go straight to external review, or the insurer did not strictly follow the internal appeal rules (then you are treated as having finished them).
- How long the review takes
Standard: 30 days; Urgent: 3 days
- Cost
External review is free. The insurer pays all costs and may not charge you a fee.
- What can be reviewed
Whether a treatment is medically necessary; whether it is experimental or investigational; whether an ongoing treatment is an active course of treatment for continuity of care; whether care is in the right setting and level of care; and whether a prescription drug formulary exception should be granted. DFR also lists rescissions and improper out-of-network billing under the federal No Surprises Act. The reviewer decides whether a case qualifies.
- Is the decision final?
The independent review organization's decision is binding on the insurer. If the insurer does not follow it, you can sue the insurer and the state can fine the insurer up to $1 million.
- How to ask
Send a written request for external review to your insurer, which must send it to DFR. DFR randomly assigns an independent review organization and mails you the case information. You can send extra information directly to the reviewer within 5 business days after you are told who was assigned. For an expedited review, include a letter from your provider and supporting documents. Questions: exreview.ins@dcbs.oregon.gov.
Law: ORS 743B.252, 743B.255, 743B.256, 743B.257, 743B.258
- Phone
Write my appeal: free letters
Sources
The official sources for Oregon are listed on the Oregon page.