External review by state
After your insurer denies the final internal appeal, you can ask an independent organization to review the decision. Each state runs its own program or uses the federal HHS-administered process. Pick yours below.
External review is a binding, independent second look by a physician reviewer with no financial tie to the insurer. It's required for every non-grandfathered commercial plan under 45 CFR § 147.136(d), and roughly 45% of externally-reviewed medical-necessity denials are overturned in the patient's favor.
Federal default under 45 CFR 147.136(d): four months after the final internal adverse benefit determination. State programs may use the same or a longer window — confirm at the linked state page before filing.
AlabamaFederal HHSAlaskaState programArizonaState programArkansasState programCaliforniaState programColoradoState programConnecticutState programDelawareState programDistrict of ColumbiaState programFloridaFederal HHSGeorgiaState programHawaiiState programIdahoState programIllinoisState programIndianaState programIowaState programKansasState programKentuckyState programLouisianaState programMaineState programMarylandState programMassachusettsState programMichiganState programMinnesotaState programMississippiFederal HHSMissouriState programMontanaState programNebraskaState programNevadaState programNew HampshireState programNew JerseyState programNew MexicoState programNew YorkState programNorth CarolinaState programNorth DakotaState programOhioState programOklahomaFederal HHSOregonState programPennsylvaniaState programRhode IslandState programSouth CarolinaState programSouth DakotaState programTennesseeFederal HHSTexasState programUtahState programVermontState programVirginiaState programWashingtonState programWest VirginiaState programWisconsinState programWyomingFederal HHS
Not legal or medical advice. This page is a self-help resource. You make your own decisions. Strip personal identifiers (name, date of birth, address, member ID) from any document before uploading or sharing. The information here summarizes commonly-published payer policies and federal rules; confirm against your specific plan document and the current denial letter before acting.