How to appeal a health insurance denial in Louisiana
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. Louisiana lets you ask an independent reviewer to decide, through Louisiana Department of Insurance. The deadline to ask: within four months of the receipt of the notice of final adverse determination.
Does this apply to you? State external review covers plans regulated by Louisiana: 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 Louisiana
Within four months of the receipt of the notice of final adverse determination
The independent review organization must decide within 72 hours after the insurer receives the expedited request. An expedited external review can be filed at the same time as an expedited internal appeal; not available for services already received.
Free (by law the insurer pays the review organization and no fee may be charged to you)
State-regulated plans (insurance bought in Louisiana or through an employer that buys insurance). Self-funded employer plans use the federal process.
Submit the written external review request to your health insurer, not the LDI; the LDI then randomly assigns an independent review organization. If the insurer says you are ineligible, you can appeal that to the Commissioner online at ldi.la.gov/onlineservices/iroconsumerappeals or 225-342-1355. Covers medical necessity, experimental/investigational and rescission denials; not short-term, limited-benefit, workers' comp or self-funded ERISA plans.
Who to contact
- Louisiana Department of Insurance
- External review information and forms
- Consumer help line: 800-259-5300
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 Louisiana?
Within four months of the receipt of the notice of final adverse determination
Can I get a fast external review in Louisiana?
The independent review organization must decide within 72 hours after the insurer receives the expedited request. An expedited external review can be filed at the same time as an expedited internal appeal; not available for services already received.
Does external review cost anything in Louisiana?
Free (by law the insurer pays the review organization and no fee may be charged to you)
Do Louisiana’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
- LDI: Understanding Your Healthcare Rights (Rev. 01/2026)
Your request for an external review must be submitted within four months of the receipt of the notice of final adverse determination.
- La. R.S. 22:2436 Standard external review
Within four months after the date of receipt of a notice of an adverse determination or final adverse determination
- La. R.S. 22:2444 Funding of external review
no fee or other charge may be levied upon a covered person for any costs of an 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.