How to appeal a health insurance denial in Alaska
The short answer
Start with your plan’s own appeal. If the plan says no again, you can usually ask an independent reviewer to decide. Alaska lets you ask an independent reviewer to decide, through Alaska Division of Insurance (Department of Commerce, Community, and Economic Development). The deadline to ask: not later than 180 days after receipt of a notice of an adverse determination or final adverse determination.
Does this apply to you? State external review covers plans regulated by Alaska: individual and Marketplace plans, and job-based plans your employer bought from an insurer. Many large employers are self-funded; their plans follow the federal external review process, and state law usually does not apply (29 CFR 2590.715-2719(c)(1)). Medicare, Medicaid, TRICARE and federal employee plans have their own appeals: see the plan guides.
External review in Alaska
Not later than 180 days after receipt of a notice of an adverse determination or final adverse determination
The independent review organization decides as fast as the condition requires and no later than 72 hours after receiving an eligible expedited request (written confirmation within 48 hours if decided orally). An expedited external review can be filed together with an expedited internal grievance when waiting would seriously jeopardize life, health or ability to regain maximum function; a physician completes the Provider Certification Form, and an oral request can be made by phone to 907-269-7900.
Free
State-regulated plans (insurance bought in Alaska or through an employer that buys insurance). Self-funded employer plans use the federal process.
File directly with the Division of Insurance by email (consumerservices@alaska.gov) or fax (907-269-7910), using the External Review Application (patient or guardian) or the Third-Party External Review Application (providers and other representatives); a signed medical-records release is required. Only denials based on medical necessity, appropriateness, setting, level of care, effectiveness, or experimental/investigational status qualify, and you normally must finish the insurer's internal grievance first; the director can extend the 180-day deadline for good cause. Consumer line is published as 1-800-INSURAK (in-state, outside Anchorage); main line 907-269-7900.
Who to contact
Before external review: the internal appeal
External review usually comes after your plan’s own appeal. The deadline for that first appeal depends on the type of plan:
- Employer plan: 180 days from the day you receive the denial notice
- Marketplace plan: 180 days from the day you receive the denial notice
- Medicare Advantage: 60 days from when you receive the denial (counted as 65 days from the notice date)
- Medicare Part D: 60 days from when you receive the denial (counted as 65 days from the notice date)
- Original Medicare: 120 days from when you receive the notice (counted as 125 days from the notice date)
- Medicaid: 60 days from the date printed on the denial notice
- FEHB (federal employees): 6 months from the date of the denial notice
- TRICARE: Mail within 90 days after the date of the denial notice
Questions people ask
How long do I have to ask for an external review in Alaska?
Not later than 180 days after receipt of a notice of an adverse determination or final adverse determination
Can I get a fast external review in Alaska?
The independent review organization decides as fast as the condition requires and no later than 72 hours after receiving an eligible expedited request (written confirmation within 48 hours if decided orally). An expedited external review can be filed together with an expedited internal grievance when waiting would seriously jeopardize life, health or ability to regain maximum function; a physician completes the Provider Certification Form, and an oral request can be made by phone to 907-269-7900.
Does external review cost anything in Alaska?
Free
Do Alaska’s rules apply to my job-based plan?
Only if the plan is fully insured, meaning your employer bought a policy from an insurance company. Self-funded employer plans generally follow the federal external review process instead. Your Summary Plan Description or HR benefits team can tell you which kind you have.
Sources
- Alaska Division of Insurance: Utilization, Internal and External Review Regulations - Consumer FAQ
Generally, the request for external review must be made within 180-days of the final adverse determination.
- 3 AAC 28.958 - Standard external review
may file a request with the director for a standard external review of a health care insurer's adverse determination or final adverse determination not later than 180 days after
- Alaska Division of Insurance: External Healthcare Review
Complaints and External Review Applications must be submitted by fax (907-269-7910) or email (consumerservices@alaska.gov).
This page is general information about appeal rules in the United States. It is not legal or medical advice. Rules can change, and your plan’s documents and your denial letter control the dates that apply to you.