External review in South Dakota: deadline, cost and how to ask
South Dakota runs its own independent review of denials: 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 South Dakota
- Program
External Review
- Who runs it
- South Dakota Division of Insurance (assigns an Independent Review Organization): Insured health benefit plans from health carriers regulated in South Dakota
- Deadline to ask
4 months
File your written request with the Division of Insurance within 4 months after you receive the notice of the adverse determination or final adverse determination.
- The deadline runs from
The date you receive the notice of the adverse determination or final adverse determination
- Do I have to appeal to my plan first?
You must usually finish the carrier's internal grievance process first. You are treated as having finished it if the carrier has not given you a written decision within 30 days after you filed the grievance (unless you asked for or agreed to a delay); this does not apply to denials of care you already received (retrospective review), where you must finish the internal process. You can ask for an expedited external review at the same time as an expedited internal review if waiting would seriously jeopardize your life, health or ability to regain maximum function.
- When you can go without a plan answer
30 days after you file your internal appeal
- Cost
External review is free for you. The health carrier pays the cost of the independent review organization.
- What can be reviewed
Denials of a covered service because the carrier said it does not meet its requirements for medical necessity, appropriateness, health care setting, level of care or effectiveness; denials because a treatment is experimental or investigational.
- Is the decision final?
The decision is binding on the carrier, and on you except to the extent you have other remedies under federal or state law. You cannot file another external review of the same denial. If the decision reverses the denial, the carrier must approve the coverage immediately.
- How to ask
Send the completed External Review Request Form with a copy of your insurance card, the carrier's final denial letter (or its waiver of the internal process), and your policy or benefit booklet to: South Dakota Division of Insurance, Attn: External Review, 124 S. Euclid Ave., 2nd Floor, Pierre, SD 57501; fax 605-773-5369; email SDComplaints@state.sd.us. Use the separate forms for expedited reviews and for experimental or investigational denials.
Law: ARSD 20:06:53:06-08, 20:06:53:12, 20:06:53:21, 20:06:53:23, 20:06:53:29, 20:06:53:33, 20:06:53:54, 20:06:53:66
- Forms and online request
- Phone
Write my appeal: free letters
Sources
The official sources for South Dakota are listed on the South Dakota page.