External review in West Virginia: deadline, cost and how to ask
West Virginia runs its own independent review of denials: Independent 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 West Virginia
- Program
Independent External Review
- Who runs it
- West Virginia Offices of the Insurance Commissioner, which assigns a state-certified Independent Review Organization (IRO): Insured health plans and HMOs regulated by the OIC. Not Medicaid, WV CHIP, Medicare, other government programs or self-funded employer plans.
- Deadline to ask
4 months
File your request with the Insurance Commissioner within 4 months of receiving the denial notice.
- The deadline runs from
Your receipt of the notice of the adverse determination or final adverse determination
- Do I have to appeal to my plan first?
You must finish your insurer's internal grievance process and get a final decision first, unless the insurer agrees in writing to skip it, or you have not received a written decision within 30 days of filing your grievance. If you qualify for an expedited external review, you can file it at the same time as an expedited internal grievance, but you must keep pursuing the internal review too.
- When you can go without a plan answer
30 days after you file your internal appeal
- Cost
There is no cost to you. The insurer pays the cost of the external review.
- What can be reviewed
Denials because services are not medically necessary (including appropriateness, setting, level of care or effectiveness) or are experimental or investigational. The service must be a covered benefit, or something that could be covered in some circumstances. External review cannot be used to pursue a malpractice or professional negligence claim.
- Is the decision final?
The decision is binding on the insurer and enforceable by the Insurance Commissioner. It is binding on you too, but you keep any other remedy in court under state or federal law. Either side can ask the circuit court to review the decision within 60 days after receiving it; the insurer must pay benefits under the decision unless a court rules otherwise.
- How to ask
Fill out the "Request for Independent External Appeal of a Healthcare Decision" form and send it with: the insurer's final internal denial letter, a copy of your insurance card, your certificate of coverage or benefit booklet if available, and any medical records or provider statements you want considered. Email it to OICHealthPolicy@wv.gov, or mail it to WV Offices of the Insurance Commissioner, ATTN: Health Policy Department, PO Box 50540, Charleston, WV 25305-0540 (fax 304-558-4965). The OIC checks within 7 business days whether the request is complete and eligible; you get 10 days to send anything missing. After acceptance you can send new information, or ask for a phone conference, within 10 days.
Law: W. Va. Code 33-16H-1 to 33-16H-4; W. Va. Code St. R. 114-97-5, 114-97-6, 114-97-7, 114-97-13
Source: the method the OIC web page gives
- Forms and online request
- Phone
1-888-879-9842; 304-720-8584; 304-558-3386
Write my appeal: free letters
Sources
The official sources for West Virginia are listed on the West Virginia page.