External review in Washington: deadline, cost and how to ask
Washington runs its own independent review of denials: Independent Review (Independent Review Organization, IRO). 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 Washington
- Program
Independent Review (Independent Review Organization, IRO)
- Who runs it
- Certified Independent Review Organizations, assigned through the Insurance Commissioner's rotational registry: Health plans regulated by the OIC (carrier-insured individual and group plans)
- Deadline to ask
180 days
You have up to 180 days to ask for external (independent) review. If you do not ask, the internal review decision becomes final and binding.
- The deadline runs from
The carrier's notice of its final internal review decision
- Do I have to appeal to my plan first?
You must first get a final internal decision, unless the carrier did not strictly follow its internal review rules or time limits (then the internal process counts as finished), the carrier waives it, or the review is about a surprise-billing (balance billing) decision under RCW 48.43.525. In urgent cases a carrier may still require you to finish the internal appeal first.
- How long the review takes
Standard: 20 days
- Cost
The carrier must provide independent review at no cost to you or your provider and pays the IRO's charges.
- What can be reviewed
Decisions to deny, change, reduce or end coverage of or payment for a health care service, including medical necessity, appropriateness, health care setting, level of care and effectiveness, experimental or investigational treatment, and surprise-billing (balance billing) decisions. There is no minimum dollar amount. Self-funded employer plans, Medicare, TRICARE and limited-benefit policies (dental-only, vision-only, accident-only, disability income, long-term care, short-term and others) are not covered.
- Is the decision final?
The IRO decision is binding unless other remedies are available under state or federal law, and the carrier must carry it out promptly.
- How to ask
Ask your carrier for independent review as explained in its final decision letter. The carrier assigns a certified IRO from the Insurance Commissioner's rotational registry and must tell you the IRO's name and contact information within one day. You then have at least 5 business days to send the IRO more information in writing. Independent review is a paper review. The carrier must keep covering ongoing treatment it is cutting for medical necessity reasons while the review is pending if you ask.
Law: RCW 48.43.535; WAC 284-43-3070, 284-43-3130, 284-43-3150(5), 284-43-3170, 284-43A-070, 284-43A-140
- Forms and online request
- Phone
Write my appeal: free letters
Sources
The official sources for Washington are listed on the Washington page.