How to appeal a health insurance denial in Montana
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. Montana lets you ask an independent reviewer to decide, through Montana Commissioner of Securities and Insurance. The deadline to ask: within 120 days after you receive the notice of the adverse determination or final adverse determination.
Does this apply to you? State external review covers plans regulated by Montana: 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 Montana
Within 120 days after you receive the notice of the adverse determination or final adverse determination
The independent review organization decides within 72 hours of receiving an eligible expedited request. You can ask your insurer for it by phone, and you can file it at the same time as an expedited internal appeal. Expedited review is not available for services you have already received.
Free (the insurer pays the independent review organization)
State-regulated plans (insurance bought in Montana or through an employer that buys insurance). Self-funded employer plans use the federal process.
There is no state request form. You send the written request to your insurer, which checks eligibility and assigns an independent review organization from the CSI-approved list. If the insurer says your case is ineligible, you can appeal that to the Commissioner, who can order the review. CSI has no dedicated external-review web page; its consumer advocates (800-332-6148 or 406-444-2040) help with appeals, so the link above is CSI's complaints and consumer-help page.
Who to contact
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 Montana?
Within 120 days after you receive the notice of the adverse determination or final adverse determination
Can I get a fast external review in Montana?
The independent review organization decides within 72 hours of receiving an eligible expedited request. You can ask your insurer for it by phone, and you can file it at the same time as an expedited internal appeal. Expedited review is not available for services you have already received.
Does external review cost anything in Montana?
Free (the insurer pays the independent review organization)
Do Montana’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
- MCA 33-32-410, Standard external review
Within 120 days after the date of receipt of a notice of an adverse determination or a final adverse determination
- MCA 33-32-411, Expedited external review
but no more than 72 hours after receiving the request for an expedited external review
- MCA 33-32-422, Funding of external review
shall pay the costs of the independent review organization for conducting the 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.