External review in Pennsylvania: deadline, cost and how to ask
Pennsylvania runs its own independent review of denials: Independent 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 Pennsylvania
- Program
Independent External Review
- Who runs it
- Pennsylvania Insurance Department (assigns a certified independent review organization): Insured job-based plans, plans bought on Pennie, and plans bought directly from an insurance company
- Deadline to ask
4 months
You must ask for an Independent External Review within 4 months after you receive the denial notice (usually the 'Final Adverse Benefit Determination Letter').
- The deadline runs from
The date you received the notice of the adverse benefit determination or final adverse benefit determination
- Do I have to appeal to my plan first?
You must finish your insurer's internal appeal first. You count as having finished it if the insurer has not decided your appeal within 30 days (unless you agreed to a delay), if the insurer waives the internal appeal, or if the insurer broke the internal appeal rules. If your life or health is at serious risk, 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
- Cost
External review is free. You cannot be charged a fee to ask for it; the insurer pays the review organization.
- What can be reviewed
Denials based on medical necessity, appropriateness of the service, health care setting, level of care, effectiveness of a covered benefit, or experimental/investigational treatment, plus disputes about the federal No Surprises Act billing and cost-sharing protections. There is no minimum dollar amount. Services your policy excludes for everyone (for example, a plan that excludes acupuncture) are not eligible, and other complaints and administrative denials go through the complaint process instead.
- Is the decision final?
The decision is final and binding on the insurer and on you, except for other remedies you may have under federal or state law. You cannot ask for a second external review of the same denial.
- How to ask
Apply online, or print the form and send it with your denial letter, a copy of your insurance card, information about your provider and any medical records by email (RA-IN-ExternalReview@pa.gov), fax (717-231-7960) or mail (Pennsylvania Insurance Department, Attn: Bureau of Managed Care, 1311 Strawberry Square, Harrisburg, PA 17120). After you are found eligible you can send more information to the assigned review organization within 15 business days. A standard review is decided within 45 days.
Law: 40 P.S. 991.2164.1-991.2164.14 (Act 146 of 2022, effective January 1, 2024)
- Forms and online request
- Phone
Write my appeal: free letters
Sources
The official sources for Pennsylvania are listed on the Pennsylvania page.