Health insurance or Medicaid said no in Rhode Island? Deadlines and free help
In Rhode Island, your health plan is regulated by Rhode Island Office of the Health Insurance Commissioner (OHIC), if it is a state-regulated plan.
Rhode Island runs its own independent review of denials: External appeal by an independent review organization (IRO). 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.
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.
Rhode Island Medicaid
You ask the state for a fair hearing. In a Medicaid health plan, you usually appeal to the plan first.
Marketplace (HealthSource RI) decision
A decision about whether you can buy a plan or get financial help is appealed to the Marketplace.
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 Rhode Island?
- Appeal to your plan
- At least 180 days from receipt of the denial (federal rule)
- Outside review
- 4 months
- Hearing deadline
- 30 days
- Appeal to the plan first
- 60 days (federal rule)
- Then a state hearing
- 120 days
- Appeal deadline – HealthSource RI
- 30 days
How do I know which plan type I have?
- Rhode Island Office of the Health Insurance Commissioner (OHIC) · 401-462-9517
Health insurers, HMOs and the review agents that make benefit and utilization review decisions for Rhode Island health plans (insured individual and employer plans)
How to tell which agency regulates your plan
If you bought insurance yourself or have insurance from an employer that does business only in Rhode Island, contact the Office of the Health Insurance Commissioner. If your coverage is through a self-insured employer (typically 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 Rhode Island
What it is called: Internal appeal (sometimes with a first-step reconsideration)
For a medical (utilization review) denial, the plan must decide your appeal within 30 calendar days of receiving it, including any reconsideration step; an urgent appeal must be decided within 72 hours. If the plan uses a reconsideration, it must decide within 15 days and you then have 45 calendar days to appeal the reconsideration decision. For other (administrative) denials, the decision is due within 30 calendar days for care not yet received and 60 days for care already received. Before the final decision you can see the whole denial and appeal file and add evidence. Coverage for an ongoing course of treatment must continue while the appeal is pending. If the plan does not strictly follow the appeal rules, you are treated as having finished the internal appeal.
Law: R.I. Gen. Laws 27-18.9-7
Step 2: Outside review in Rhode Island
External appeal by an independent review organization (IRO)
Deadline to ask: 4 months.
Urgent care in Rhode Island: faster decisions
Outside review
For urgent or emergent care the IRO decides as fast as possible and within 72 hours of receiving the request. For a denial of a non-covered drug, the IRO decides within 72 hours, or 24 hours if the original request was expedited.
Law: R.I. Gen. Laws 27-18.9-8; R.I. Gen. Laws 230-RICR-20-30-14
Source: oral notice must be followed in writing within 48 hours
Medicaid
You can ask for an expedited appeal if the standard process could jeopardize your life, health or ability to attain, maintain or regain maximum function. Include information supporting the request. If granted, the hearing is scheduled quickly (within 3 business days for people with both Medicare and Medicaid).
Law: 210-RICR-10-05-2 (EOHHS Appeals Process and Procedures)
Marketplace
You can ask for an expedited appeal if you have an immediate need for health services and the standard appeal could jeopardize your life, health or ability to attain, maintain or regain maximum function.
Law: 210-RICR-10-05-2, §§ 2.2.1(A)(9), 2.2.2, 2.4.3, 2.4.4
Complaints about your plan in Rhode Island
For other problems with a health insurer, contact the Office of the Health Insurance Commissioner (401-462-9517, OHIC.HealthInsInq@ohic.ri.gov) or the RIPIN Health Insurance Consumer Support line.
Medicaid (Rhode Island Medicaid (RIte Care, Rhody Health Partners)) denials in Rhode Island
Who holds the hearing: EOHHS Appeals Office (EOHHS Hearing Office, EHO).
Hearing deadline: 30 days
Marketplace decisions in Rhode Island
- Marketplace
- Appeal deadline
30 days
The contested decision; the 30 days begin 5 days after the mailing date of the notice
- How to appeal
File an appeal with the EOHHS Appeals Office online through your account, or with the EOHHS appeal form by mail, fax or delivery. An informal resolution may be offered first; it is voluntary.
- Faster appeal
You can ask for an expedited appeal if you have an immediate need for health services and the standard appeal could jeopardize your life, health or ability to attain, maintain or regain maximum function.
- Coverage while you appeal
If you appeal within 30 days of an eligibility redetermination, your qualified health plan eligibility, premium tax credit and cost-sharing reductions can continue while the appeal is pending.
- If you disagree
You can appeal to the U.S. Department of Health and Human Services within 30 days of the date of the hearing decision notice.
Law: 210-RICR-10-05-2, §§ 2.2.1(A)(9), 2.2.2, 2.4.3, 2.4.4
Other rights in Rhode Island
Ongoing treatment continues during an appeal
Benefits for an ongoing course of treatment cannot be reduced or ended without advance notice and a chance for review, and the plan must keep covering it while your appeal is pending.
Law: R.I. Gen. Laws 27-18.9-7(a)(9)
Fast appeals for non-covered drugs
If a drug is denied as not covered, the plan must decide your appeal within 72 hours, or within 24 hours if your health is seriously at risk or you are already taking a non-formulary drug. If approved, coverage lasts for the whole prescription, including refills.
Law: R.I. Gen. Laws 27-18.9-7(b)(6)
Doctor-to-doctor talk before a reconsideration
Before a plan reconsiders a medical denial, its reviewer must speak directly with your treating doctor (or make two reasonable attempts). The appeal reviewer must be in the same or a similar specialty when the denial is based on medical judgment.
Law: R.I. Gen. Laws 27-18.9-7(b)(3), (b)(5)
How long do I have? Deadline calculator
Pick your plan type and enter the dates on your notice. We count from the rules in Rhode Island and the federal rules.
Write my appeal: free letters
Free help in Rhode Island
- Rhode Island Parent Information Network (RIPIN), Health Insurance Consumer Support · 401-270-0101
Listed by HHS as Rhode Island's Consumer Assistance Program: free help with health insurance questions, problems and appeals. - Office of the Health Insurance Commissioner (OHIC) · 401-462-9517
State regulator for insurance you bought yourself or got from an employer that does business only in Rhode Island. - Rhode Island Legal Services (HelpRILaw.org, LawHelp.org network)
- CMS help page for this state
- LawHelp.org
- Your state's Consumer Assistance Program (CAP) or insurance department
- U.S. Department of Labor, Employee Benefits Security Administration (EBSA) · 1-866-444-3272
- HealthCare.gov Marketplace Call Center and local help · 1-800-318-2596
- CCIIO Health Insurance Assistance Team · 1-888-393-2789
- Legal Services Corporation (LSC) - Find legal aid
Good to know in Rhode Island
- Rhode Island lets plans charge up to $25 for an external appeal, refundable if you win, waived for hardship and capped at $75 a year.
Law: R.I. Gen. Laws 27-18.9-8(a)(5)
- Rhode Island Medicaid and HealthSource RI appeals must be filed within 30 days, counted from 5 days after the notice was mailed.
Law: 210-RICR-10-05-2, § 2.2.1(A)(9)
- Rhode Island plans must keep covering an ongoing course of treatment while an appeal is pending.
Law: R.I. Gen. Laws 27-18.9-7(a)(9)
Questions about appeals in Rhode Island
How long do I have to appeal a health insurance denial in Rhode Island?
You have at least 180 calendar days after you receive the denial notice to appeal. 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 Rhode Island?
External appeal by an independent review organization (IRO). Ask your plan or its review agent for an external appeal (instructions are in your final appeal notice). The plan picks the IRO from OHIC's rotation list.
Is outside review free in Rhode Island?
The plan may charge you up to $25 for an external appeal. The fee is refunded if the denial is reversed, must be waived if paying it would be an undue financial hardship, and is capped at $75 a plan year.
How long do I have to ask for a Medicaid fair hearing in Rhode Island?
30 days. The contested agency action; the 30 days begin 5 days after the mailing date of the notice
Can I keep my Medicaid benefits while I appeal in Rhode Island?
Your Medicaid continues (aid pending) if you appeal during the advance notice period: 10 days that begin on the fifth day after the date on the notice of intended action. If that period ends on a weekend or holiday, an appeal received the next business day still counts.
How do I appeal a Marketplace decision in Rhode Island?
File an appeal with the EOHHS Appeals Office online through your account, or with the EOHHS appeal form by mail, fax or delivery. An informal resolution may be offered first; it is voluntary.