Health insurance or Medicaid said no in Wyoming? Deadlines and free help
In Wyoming, your health plan is regulated by Wyoming Department of Insurance, if it is a state-regulated plan.
Wyoming runs its own independent review of denials: Independent Medical Claim Review (External Review). You generally have 120 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.
Wyoming 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.
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.
Some of Wyoming's rules rest on limited sources.
Check the official sources below, or ask a legal aid office, before you rely on them.
How long do I have in Wyoming?
- Appeal to your plan
- At least 180 days from receipt of the denial (federal rule)
- Outside review
- 120 days
- Hearing deadline
- 20 business days
- Appeal deadline – HealthCare.gov
- 90 days (federal rule)
How do I know which plan type I have?
- Wyoming Department of Insurance · 307-777-7402 · Complaint form
Health insurance companies and HMOs, including insurance you buy yourself and insured job-based plans
How to tell which agency regulates your plan
If you bought insurance yourself or have insurance from an employer that does business only in Wyoming, contact the Wyoming Department of Insurance. If your plan is a self-insured employer plan (often a large company or one in several states), contact the U.S. Department of Labor. Most self-funded plans are not eligible for Wyoming's external review.
Law: Wyoming External Review Request Form (1/25/2024)
Step 1: Appeal to your plan in Wyoming
What it is called: Internal review of a denied claim
When a claim is denied as not medically necessary, the insurer must explain in writing why. The insurer must complete its review and send you a decision within 45 days after it receives your request. An expedited review must be done as fast as your condition requires and within 72 hours if waiting would seriously jeopardize your life, health or ability to regain maximum function, or if you got emergency care and have not been discharged. Federal claims rules can require a faster decision.
Law: Wyo. Stat. 26-40-201(c)-(d), (s)
Step 2: Outside review in Wyoming
Independent Medical Claim Review (External Review)
Deadline to ask: 120 days.
Urgent care in Wyoming: faster decisions
Outside review
If a standard review would seriously jeopardize your life, health or ability to regain maximum function, or you got emergency care and have not been discharged, send the request form with your treating physician's certificate directly to your insurer. The decision is due within 72 hours.
Law: Wyo. Stat. 26-40-201(e)-(r)
Complaints about your plan in Wyoming
You can file a complaint against an insurance company with the Wyoming Department of Insurance online through its consumer complaint portal, or contact Consumer Affairs at 307-777-7402 (toll-free 800-438-5768). Mailing address: Wyoming Department of Insurance, 106 E 6th Ave, Cheyenne, WY 82002.
Medicaid (Wyoming Medicaid) denials in Wyoming
Who holds the hearing: Wyoming Office of Administrative Hearings (OAH), on referral from the Wyoming Department of Health.
Hearing deadline: 20 business days
Marketplace decisions in Wyoming
Wyoming uses HealthCare.gov. Appeals go to the federal Marketplace Appeals Center.
Other rights in Wyoming
Medical necessity denials must be explained
If an insurer denies a claim as not medically necessary after its review, it must explain why in writing and, if you ask, include the signed opinion of at least one medical consultant who agrees with the denial and is not the insurer's employee.
Law: Wyo. Stat. 26-40-201(e)(i)
Prior authorization rules (Ensuring Transparency in Prior Authorization Act, from July 1, 2024)
Health insurers and their review companies must decide non-urgent prior authorization requests within 5 calendar days and urgent ones within 72 hours after getting all needed information; an urgent request not answered in 72 hours is treated as approved. Denials and appeals of denials must be decided by a physician or other licensed health care provider, and appeals by someone not involved in the first denial. Approvals for outpatient services and prescription drugs last at least 1 year, and a new plan must honor a prior plan's approval for at least 90 days. You cannot be required to repeat a step therapy drug you already tried and stopped because it did not work or caused problems.
Law: Wyo. Stat. 26-55-101 to 26-55-113 (2024 Wyo. Sess. Laws, HB0014, Enrolled Act 14)
How long do I have? Deadline calculator
Pick your plan type and enter the dates on your notice. We count from the rules in Wyoming and the federal rules.
Write my appeal: free letters
Free help in Wyoming
- Wyoming Insurance Department · 307-777-7402
Listed by HHS as the agency to contact about insurance you bought yourself or from an employer that does business only in Wyoming. - Wyoming Medicaid Program · 855-294-2127
Questions about Medicaid or Kid Care CHIP eligibility or current benefits. - Legal Aid of Wyoming · 877-432-9955
- CMS help page for this state
- LawHelp.org
- Your state's Consumer Assistance Program (CAP) or insurance department
- U.S. Department of Labor, Employee Benefits Security Administration (EBSA) · 1-866-444-3272
- HealthCare.gov Marketplace Call Center and local help · 1-800-318-2596
- CCIIO Health Insurance Assistance Team · 1-888-393-2789
- Legal Services Corporation (LSC) - Find legal aid
Good to know in Wyoming
- In Wyoming you send the external review request to your insurance company, not to the state; the insurer assigns the independent review organization and notifies the Department of Insurance.
Law: Wyo. Stat. 26-40-201(f)-(g)
- Wyoming gives 120 days to ask for external review and charges a $15 filing fee that can be waived for hardship (Wyo. Stat. 26-40-201(f), (r); Wyoming Department of Insurance).
- Wyoming's Medicaid rules set the hearing request deadline at 20 business days after the notice of adverse action is mailed.
Law: Wyoming Medicaid Rules ch. 4, sec. 7
Changes in 2024–2026
2024 HB0014 created the Ensuring Transparency in Prior Authorization Act, effective July 1, 2024: 5-day non-urgent and 72-hour urgent prior authorization decisions, physician/licensed-provider review of denials and appeals, longer-lasting approvals and step therapy protections. Its provider exemption ('gold card') section, 26-55-112, took effect January 1, 2026.
Law: Wyo. Stat. 26-55-101 to 26-55-113
Questions about appeals in Wyoming
How long do I have to appeal a health insurance denial in Wyoming?
Wyoming law requires insurers to give you at least 30 days to ask the insurer to review a medical necessity denial. Federal rules give at least 180 days for most plans, and an insurer that follows the federal (ERISA) appeal rules is treated as complying with the Wyoming law. 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 Wyoming?
Independent Medical Claim Review (External Review). Fill out Wyoming's official External Review Request Form (your insurer must give it to you with the final denial). Send it, with a duplicate copy, to your insurer at the address it gives, together with a copy of your insurance card, the insurer's final denial letter (or waiver, or your provider's expedited certification) and the $15 fee or fee waiver request.
Is outside review free in Wyoming?
There is a $15 filing fee, paid by check or money order to the Wyoming State Treasurer. It can be waived if your income is at or below the federal poverty guidelines.
How long do I have to ask for a Medicaid fair hearing in Wyoming?
20 business days. The date the notice of adverse action was mailed (20 business days, not calendar days)
Can I keep my Medicaid benefits while I appeal in Wyoming?
If you ask for a hearing before the effective date of the action on your notice, your Medicaid services cannot be ended or reduced until the final hearing decision (unless the hearing officer finds the only issue is federal or state law or policy). The Department must mail the notice at least 10 business days before the effective date.
Who regulates health insurance in Wyoming?
Wyoming Department of Insurance. If you bought insurance yourself or have insurance from an employer that does business only in Wyoming, contact the Wyoming Department of Insurance. If your plan is a self-insured employer plan (often a large company or one in several states), contact the U.S. Department of Labor. Most self-funded plans are not eligible for Wyoming's external review.
Not about a denied claim?
Nearby states
Sources
- Wyo. Stat. 26-40-201 (Title 26 PDF, Wyoming Legislature)
- Wyoming Department of Insurance, Independent Medical Claim Review Process
- Wyoming External Review Request Form and checklist (rev. 1/25/2024)
- Wyoming Department of Insurance, Consumers
- Wyoming Medicaid Rules ch. 4, Medicaid Administrative Hearings (eff. 3/24/2020)
- WDH Eligibility Online Manual, M1900 Informal Conferences/Administrative Hearings
- CMS CCIIO, Wyoming Consumer Assistance
- Wyoming HB0014 (2024), Enrolled Act 14, Ensuring Transparency in Prior Authorization Act
- WDH Eligibility Online Manual, M406 Defining Client Rights