How to appeal a health insurance denial in Arkansas
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. Arkansas lets you ask an independent reviewer to decide, through Arkansas Insurance Department. The deadline to ask: within four (4) months after the date of receipt of a notice of an adverse determination or final adverse determination.
Does this apply to you? State external review covers plans regulated by Arkansas: 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 Arkansas
Within four (4) months after the date of receipt of a notice of an adverse determination or final adverse determination
The independent review organization must decide within 72 hours. An expedited external review can be filed at the same time as an expedited internal appeal when the internal timeframe would seriously jeopardize life or health; the treating provider must complete the physician certification, and you should call the department before sending an expedited request.
Free
State-regulated plans (insurance bought in Arkansas or through an employer that buys insurance). Self-funded employer plans use the federal process.
Send the signed External Review Request Form (it includes a medical-records release) to the Arkansas Insurance Department, not the insurer: email insurance.externalreview@arkansas.gov or fax 501-371-2734 (new since April 1, 2025), with a copy of your ID card, the final denial letter and your policy or benefit booklet. Only medical-necessity, setting, level-of-care, effectiveness and experimental/investigational denials qualify; dental, vision, long-term care, disability, accident-only, hospital indemnity, short-term medical, Medicare, Medicaid and self-funded plans are excluded. The External Review Section can be reached at 800-852-5494. The department's External Review web page currently loads without its FAQ text, so the deadline here is taken from Rule 76.
Who to contact
- Arkansas Insurance Department
- External review information and forms
- Consumer help line: 800-852-5494
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 Arkansas?
Within four (4) months after the date of receipt of a notice of an adverse determination or final adverse determination
Can I get a fast external review in Arkansas?
The independent review organization must decide within 72 hours. An expedited external review can be filed at the same time as an expedited internal appeal when the internal timeframe would seriously jeopardize life or health; the treating provider must complete the physician certification, and you should call the department before sending an expedited request.
Does external review cost anything in Arkansas?
Free
Do Arkansas’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
- Arkansas Insurance Department Rule 76 (23 CAR pt. 117), Section 8
Within four (4) months after the date of receipt of a notice of an adverse determination or final adverse determination
- Arkansas Insurance Department Bulletin 5-2025
New Email address: insurance.externalreview@arkansas.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.