How to appeal a health insurance denial in Kentucky
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. Kentucky lets you ask an independent reviewer to decide, through Kentucky Department of Insurance. The deadline to ask: within four months of receipt of your upheld (final internal appeal) denial letter; the request goes to your insurer.
Does this apply to you? State external review covers plans regulated by Kentucky: 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 Kentucky
Within four months of receipt of your upheld (final internal appeal) denial letter; the request goes to your insurer
The independent review entity decides within 24 hours of receiving all information from the insurer (a 24-hour extension is allowed if both sides agree); DOI guidance caps expedited reviews at 72 hours. Expedited requests may be made orally, and in urgent cases can run at the same time as an expedited internal appeal.
$25 one-time filing fee paid to the independent review entity; waived for financial hardship and refunded if the decision is in your favor (DOI guidance: $75 cap per plan year)
State-regulated plans (insurance bought in Kentucky or through an employer that buys insurance). Self-funded employer plans use the federal process.
Send the written request plus a signed medical-records release to your insurer, not the DOI; the insurer obtains a DOI-assigned independent review entity. KRS 304.17A-623(4) still says 60 days, but the DOI's consumer guide and its 2026 utilization review guide say the 4-month federal ACA timeframe applies (file within 60 days to be safe, especially for grandfathered plans). Denials based on a plan exclusion or limit go first to the DOI Coverage Denial Coordinator (P.O. Box 517, Frankfort, KY 40602).
Who to contact
- Kentucky Department of Insurance
- External review information and forms
- Consumer help line: 800-595-6053
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 Kentucky?
Within four months of receipt of your upheld (final internal appeal) denial letter; the request goes to your insurer
Can I get a fast external review in Kentucky?
The independent review entity decides within 24 hours of receiving all information from the insurer (a 24-hour extension is allowed if both sides agree); DOI guidance caps expedited reviews at 72 hours. Expedited requests may be made orally, and in urgent cases can run at the same time as an expedited internal appeal.
Does external review cost anything in Kentucky?
$25 one-time filing fee paid to the independent review entity; waived for financial hardship and refunded if the decision is in your favor (DOI guidance: $75 cap per plan year)
Do Kentucky’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
- Kentucky DOI: Appealing a Denial From Your Health Benefit Plan (Expanded Version)
The appeal must be made to your insurer within four months of receipt of your upheld denial letter.
- Kentucky DOI 2026 Utilization Management Review Guide (Rev. 01.06.2026)
KY timeframe preempted by Federal ACA
- KRS 304.17A-623 (effective July 15, 2026)
shall submit a request for external review to the insurer within sixty (60) days
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.