How to appeal a health insurance denial in Nevada
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. Nevada lets you ask an independent reviewer to decide, through Nevada Office for Consumer Health Assistance (Aging and Disability Services Division). The deadline to ask: within four (4) months of receiving the denial notice from your health plan.
Does this apply to you? State external review covers plans regulated by Nevada: 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 Nevada
Within four (4) months of receiving the denial notice from your health plan
Within 72 hours of receiving your provider's proof of urgency, OCHA decides whether to expedite the review and then assigns an independent review organization within 1 working day. The reviewer must finish within 48 hours of the assignment. You need the Healthcare Provider Certification Form, and you should call OCHA before sending the paperwork.
Free (the insurer that made the denial pays)
State-regulated plans (insurance bought in Nevada or through an employer that buys insurance). Self-funded employer plans use the federal process.
Send external review requests to the Office for Consumer Health Assistance (cha@govcha.nv.gov, fax 702-486-3586), not to the Division of Insurance. The Division of Insurance (doi.nv.gov, 888-872-3234) regulates insurers and takes complaints, but by law OCHA receives external review requests. Only medical-necessity and experimental/investigational denials qualify. If your insurer gives no written decision within 30 days of your internal grievance, you may go straight to external review. A standard review is decided within 15 days after the reviewer has the information it needs.
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 Nevada?
Within four (4) months of receiving the denial notice from your health plan
Can I get a fast external review in Nevada?
Within 72 hours of receiving your provider's proof of urgency, OCHA decides whether to expedite the review and then assigns an independent review organization within 1 working day. The reviewer must finish within 48 hours of the assignment. You need the Healthcare Provider Certification Form, and you should call OCHA before sending the paperwork.
Does external review cost anything in Nevada?
Free (the insurer that made the denial pays)
Do Nevada’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
- OCHA External Review Request Form (Rev. 6/16/2025)
Submit this form to the Office for Consumer Health Assistance within FOUR (4) MONTHS of receiving denial notice of payment or coverage from your health plan.
- NRS 695G.251
within 4 months after receiving notice of the adverse determination, submit a request to the Office for Consumer Health Assistance for an external review
- NRS 695G.271 (as amended 2025)
Complete its external review not later than 48 hours after receiving the assignment
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.