How to appeal a health insurance denial in Iowa
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. Iowa lets you ask an independent reviewer to decide, through Iowa Insurance Division. The deadline to ask: within 4 months of the date of receipt of the final adverse claim determination notice.
Does this apply to you? State external review covers plans regulated by Iowa: 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 Iowa
Within 4 months of the date of receipt of the final adverse claim determination notice
Decision within 72 hours. The treating provider must certify the need and may call the Division to request it verbally. It can be requested when you receive the initial urgent denial, at the same time as an expedited internal appeal.
Free (the insurance company pays)
State-regulated plans (insurance bought in Iowa or through an employer that buys insurance). Self-funded employer plans use the federal process.
Submit the Division's External Review Request Form to the Iowa Insurance Division (1963 Bell Avenue, Suite 100, Des Moines, IA 50315; fax 515-654-6500; iid.marketregulation@iid.iowa.gov). You can file without finishing the internal appeal if the insurer has not decided it within 30 days. Only medical-necessity-type and experimental/investigational denials qualify. The 877 number is toll-free within Iowa only (main line 515-654-6600).
Who to contact
- Iowa Insurance Division
- External review information and forms
- Consumer help line: 877-955-1212
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 Iowa?
Within 4 months of the date of receipt of the final adverse claim determination notice
Can I get a fast external review in Iowa?
Decision within 72 hours. The treating provider must certify the need and may call the Division to request it verbally. It can be requested when you receive the initial urgent denial, at the same time as an expedited internal appeal.
Does external review cost anything in Iowa?
Free (the insurance company pays)
Do Iowa’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
- Iowa Insurance Division: Consumer Connection: How to Appeal Denied Health Insurance Claims
An external review must be filed with the Iowa Insurance Division within 4 months of the date of receipt of the final adverse claim determination notice.
- Iowa Code §514J.107 External review, standard
may file a written request for an external review with the commissioner within four months after any of the following events
- Iowa Admin. Code 191—76.4 External review request
There is no charge or fee for submitting a request for external review.
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.