Health insurance or Medicaid said no in Utah? Deadlines and free help

In Utah, your health plan is regulated by Utah Insurance Department (UID), if it is a state-regulated plan.

Utah runs its own independent review of denials: Independent Review. 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.

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.

Utah Medicaid

You ask the state for a fair hearing. In a Medicaid health plan, you usually appeal to the plan first.

Marketplace (HealthCare.gov) decision

A decision about whether you can buy a plan or get financial help is appealed to the Marketplace.

How long do I have?Urgent care: faster decisionWrite my appealFree help

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 Utah?

Appeal to your plan
At least 180 days from receipt of the denial (federal rule)
Outside review
180 days
Hearing deadline
30 days for services, 90 days for eligibility
Appeal to the plan first
60 days (federal rule)
Then a state hearing
120 days
Appeal deadline – HealthCare.gov
90 days (federal rule)

All the details →

How long do I have? Deadline calculator

How do I know which plan type I have?

How to tell which agency regulates your plan

Check your health insurance ID card. "State Regulated" on the front or back means the Utah Insurance Department can help (if the policy was bought in Utah). "Administered by" usually means a self-funded employer plan, which the state does not regulate; contact your employer or the U.S. Department of Labor.

Step 1: Appeal to your plan in Utah

What it is called: Internal appeal (internal review) with your insurance carrier

You must first ask your insurance carrier for an internal appeal. The carrier may not charge you for it. Utah requires carriers' appeal procedures to follow the federal claims and appeals rules.

Law: 29 CFR 2560.503-1 and 45 CFR 147.136; Utah Code 31A-22-629(3), (5)(b); Utah Admin. Code R590-261-4

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Step 2: Outside review in Utah

Independent Review

Deadline to ask: 180 days.

All the details →

Urgent care in Utah: faster decisions

Outside review

Expedited review is available if the condition could seriously jeopardize your life, health or ability to regain maximum function, if your provider says you would face severe pain that cannot be managed without the care, or if you got emergency care and have not left the facility. Your physician must complete the expedited certification page of the request form.

Law: Utah Code 31A-22-629; Utah Admin. Code R590-261-6, -8, -9, -10, -11

Medicaid

If waiting could endanger the member's life, health or ability to attain, maintain or regain maximum function, call Administrative Hearings at 801-538-6576 to request an expedited hearing.

Law: Utah Admin. Code R410

Complaints about your plan in Utah

If you cannot resolve a problem with your insurance company or agent, you can file a complaint through the Utah Insurance Department's online Complaint Portal or with a PDF form. The Department sends it to the company for a response and gives you its findings, usually in three to four weeks.

insurance.utah.gov

Medicaid (Utah Medicaid) denials in Utah

Who holds the hearing: DHHS Office of Administrative Hearings (services, managed care and disability decisions); DWS Division of Adjudication, Fair Hearings (Medicaid and CHIP eligibility).

Hearing deadline: 30 days for services, 90 days for eligibility

All the details →

Marketplace decisions in Utah

Utah uses HealthCare.gov. Appeals go to the federal Marketplace Appeals Center.

HealthCare.gov

1-855-231-1751

Other rights in Utah

Drugs not on the plan's list

Carriers must offer a standard exception request, an expedited exception request and an external exception review by an independent review organization for a drug that is not on the plan's formulary. A granted exception is treated as an essential health benefit, and your cost-sharing counts toward the plan's yearly out-of-pocket limit.

Law: Utah Admin. Code R590-261-12; 45 CFR 156.122

How long do I have? Deadline calculator

Pick your plan type and enter the dates on your notice. We count from the rules in Utah and the federal rules.

Worked out in your browser. Nothing you enter here is saved or sent.

If you are not sure when it arrived, use the date printed on the notice. That date is never later than the day it arrived.

Choose what was decided and enter the date on your notice

We add the number of days or months from the law to your date. Nothing is saved.

Write my appeal: free letters

Free help in Utah

Good to know in Utah

  • Utah gives you 180 calendar days after the final denial to ask for independent review, longer than the federal minimum of 4 months.

    Law: Utah Admin. Code R590-261-8(2)(a)

  • In Utah, a fair hearing on a Medicaid agency decision about services must be requested within 30 days of the date the notice was sent, while eligibility decisions have 90 days.
  • Medicaid and CHIP eligibility hearings are handled by the Department of Workforce Services, not by the DHHS Office of Administrative Hearings (Utah DHHS, Hearings).

Changes in 2024–2026

August 7, 2025: the Utah Insurance Department's amendment to R590-261 took effect (filing no. 57248, published in the Utah State Bulletin July 1, 2025). It updates the independent review web address in required notices and adds a non-formulary drug exception process (R590-261-12) that follows 45 CFR 156.122. Starting January 1, 2027, some adults in Adult Expansion Medicaid and Targeted Adult Medicaid may need to meet a community engagement requirement and complete an eligibility review every 6 months (Utah DHHS).

Questions about appeals in Utah

How long do I have to appeal a health insurance denial in Utah?

Utah law does not set a different time to file. Use the deadline on your denial notice; federal rules give at least 180 days for most plans. 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 Utah?

Independent Review. Fill out the Independent Review Request Form, sign the medical records release, and send it with a copy of your insurance card and the denial letter to the Utah Insurance Department by mail, fax or email. For an urgent case or an experimental-treatment denial, add the physician certification page.

Is outside review free in Utah?

Free to you. You cannot be charged a fee to request independent review; the carrier pays the independent review organization.

How long do I have to ask for a Medicaid fair hearing in Utah?

30 days for services, 90 days for eligibility. The date the Medicaid agency sent its denial notice (decisions about services by the Medicaid agency).

Can I keep my Medicaid benefits while I appeal in Utah?

Services: send the hearing form and a signed request to continue services within 10 calendar days of the date the Medicaid agency's notice was sent (or after the plan sent its appeal decision). Eligibility: medical benefits continue if you ask for a hearing before the effective date of the action or within 10 calendar days of receiving the notice, whichever is longer; the notice is treated as received 5 days after its date.

Who regulates health insurance in Utah?

Utah Insurance Department (UID). Check your health insurance ID card. "State Regulated" on the front or back means the Utah Insurance Department can help (if the policy was bought in Utah).

Not about a denied claim?

Nearby states

Sources

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