How to appeal a health insurance denial in Indiana
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. Indiana lets you ask an independent reviewer to decide, through Indiana Department of Insurance. The deadline to ask: not more than 120 days after you are notified of the insurer's appeal resolution.
Does this apply to you? State external review covers plans regulated by Indiana: 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 Indiana
Not more than 120 days after you are notified of the insurer's appeal resolution
For an expedited external grievance, the independent review organization decides within 72 hours after the grievance is filed (standard reviews take 15 business days).
Free (the insurer pays all independent review organization costs)
State-regulated plans (insurance bought in Indiana or through an employer that buys insurance). Self-funded employer plans use the federal process.
Indiana calls this an "external grievance." You file the written request with your insurer or HMO, not with IDOI, and the insurer assigns the next IDOI-certified independent review organization in rotation; IDOI's page links each insurer's filing procedure. You may file only one external grievance per appeal decision. HMO members have the same 120-day window under IC 27-13-10.1.
Who to contact
- Indiana Department of Insurance
- External review information and forms
- Consumer help line: 800-622-4461
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 Indiana?
Not more than 120 days after you are notified of the insurer's appeal resolution
Can I get a fast external review in Indiana?
For an expedited external grievance, the independent review organization decides within 72 hours after the grievance is filed (standard reviews take 15 business days).
Does external review cost anything in Indiana?
Free (the insurer pays all independent review organization costs)
Do Indiana’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
- Indiana Code §27-8-29-13 (external grievance procedure)
not more than one hundred twenty (120) days after the covered individual is notified of the resolution
- Indiana Code §27-8-29-15 (IRO determinations)
for an expedited external grievance filed under section 13(a)(2)(A) of this chapter, within seventy-two (72) hours after the external grievance is filed
- IDOI: Internal and External Grievance Procedures
It is important to follow the deadlines stated in your EOB or your policy or certificate
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.