External review in Utah: deadline, cost and how to ask
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.
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 Utah
- Program
Independent Review
- Who runs it
- Utah Insurance Department, Health Division, which assigns an approved independent review organization at random: Non-grandfathered health benefit plans from insurance companies, HMOs and other carriers regulated in Utah. Some plans have the process run by the carrier; ask your carrier. Self-funded plans may choose to use it.
- Deadline to ask
180 days
You have 180 calendar days after you receive the carrier's final denial to send your request to the Utah Insurance Department. If you send it to the carrier by mistake, the carrier must forward it to the Department within 1 business day.
- The deadline runs from
The date you receive the notice of the final adverse benefit determination (the carrier's final internal appeal decision)
- Do I have to appeal to my plan first?
You must finish the carrier's internal review first, unless the carrier agrees to waive it, the carrier did not follow its own internal review process (other than a minor violation that did not harm you), or you ask for an expedited independent review at the same time as an expedited internal review.
- Cost
Free to you. You cannot be charged a fee to request independent review; the carrier pays the independent review organization.
- What can be reviewed
Denials, reductions or terminations based on medical necessity, appropriateness, health care setting, level of care or effectiveness; treatments denied as experimental or investigational; and rescission of coverage. Grandfathered and transitional plans are not covered. The carrier first checks whether you were covered, the service is a covered benefit and you finished internal review; you can appeal a finding that you are not eligible to the Insurance Commissioner.
- Is the decision final?
The decision is binding on the carrier and on you, except where other remedies are available under federal or state law. If the reviewer overturns the denial, the carrier must approve coverage and process the benefit within 1 business day.
- How to ask
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. After you are accepted, you have 5 business days to send extra information to the reviewer.
Law: Utah Code 31A-22-629; Utah Admin. Code R590-261-6, -8, -9, -10, -11
Source: one form per denial
- Forms and online request
- Phone
801-957-9280 (fax 385-465-6047; email healthappeals@utah.gov)
Write my appeal: free letters
Sources
The official sources for Utah are listed on the Utah page.