External review in Rhode Island: deadline, cost and how to ask
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.
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 Rhode Island
- Program
External appeal by an independent review organization (IRO)
- Who runs it
- Independent review organization approved by OHIC, chosen from OHIC's rotational IRO registry: Insured health plans regulated by OHIC (non-administrative, that is medical, denials)
- Deadline to ask
4 months
You have at least 4 months after you receive the final internal appeal decision to ask for an external appeal.
- The deadline runs from
The date you receive the notice of the decision on your final internal appeal
- Do I have to appeal to my plan first?
You must finish the internal appeal first, unless the plan failed to follow the internal appeal rules or you ask for an expedited external review at the same time as an expedited internal appeal.
- Cost
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. There is no minimum claim amount.
- What can be reviewed
Non-administrative adverse benefit determinations, that is denials based on medical judgment, such as medical necessity, appropriateness or experimental/investigational treatment, including non-covered drug denials. Excepted benefits (such as stand-alone dental or vision) are not covered by these rules.
- Is the decision final?
The IRO decision is binding on the plan, which must pay or provide the benefit without delay even if it goes to court. Anyone who disagrees with the decision can seek review in court.
- How to ask
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. You will have at least 5 business days after the external appeal notice to send more information to the IRO. The IRO decides within 10 calendar days of getting all the information it needs, and no later than 45 calendar days after the request.
Law: R.I. Gen. Laws 27-18.9-8; R.I. Gen. Laws 230-RICR-20-30-14
- Phone
Write my appeal: free letters
Sources
The official sources for Rhode Island are listed on the Rhode Island page.