How to appeal a health insurance denial in Mississippi
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. Mississippi lets you ask an independent reviewer to decide, through Mississippi Insurance Department. The deadline to ask: within four (4) months after receipt from your insurer of a denial.
Does this apply to you? State external review covers plans regulated by Mississippi: 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 Mississippi
Within four (4) months after receipt from your insurer of a denial
The review organization decides within 72 hours of receiving an eligible expedited request. It can be requested along with an expedited internal appeal; your treating provider must complete the expedited form, and you should call the Department (601-359-3569) before sending paperwork. Not available for services already received.
Free (the insurer pays the independent review organization)
State-regulated plans (insurance bought in Mississippi or through an employer that buys insurance). Self-funded employer plans use the federal process.
Send the signed request form (with medical-records release, the denial and your certificate of coverage) to the Mississippi Insurance Department, Life and Health Actuarial Division, P.O. Box 79, Jackson, MS 39205, not to the insurer. Covers denials based on medical necessity, appropriateness, setting, level of care or effectiveness, and experimental/investigational treatment. External review help line: 601-359-3569.
Who to contact
- Mississippi Insurance Department
- External review information and forms
- Consumer help line: 800-562-2957
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 Mississippi?
Within four (4) months after receipt from your insurer of a denial
Can I get a fast external review in Mississippi?
The review organization decides within 72 hours of receiving an eligible expedited request. It can be requested along with an expedited internal appeal; your treating provider must complete the expedited form, and you should call the Department (601-359-3569) before sending paperwork. Not available for services already received.
Does external review cost anything in Mississippi?
Free (the insurer pays the independent review organization)
Do Mississippi’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
- MID External Review Request Form (Rule 15.22 Appendix B)
must be filed with Mississippi Insurance Department within FOUR (4) MONTHS after receipt from your insurer of a denial
- Mississippi Health Carrier External Review Regulation (19 Miss. Admin. Code Pt. 3, Ch. 15)
Within four (4) months after the date of receipt of a notice of an adverse determination or final adverse determination
- 19 Miss. Code R. 3-15.08 Expedited External Review
in no event more than seventy-two (72) hours after the date of receipt of the request for an expedited 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.