How to appeal a health insurance denial in Utah
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. Utah lets you ask an independent reviewer to decide, through Utah Insurance Department. The deadline to ask: within 180 calendar days after receiving a notice of a final adverse benefit determination.
Does this apply to you? State external review covers plans regulated by Utah: 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 Utah
Within 180 calendar days after receiving a notice of a final adverse benefit determination
Available if waiting could seriously jeopardize your life, health or ability to regain maximum function, would cause severe pain, or involves an emergency stay before discharge. The IRO must decide no later than 72 hours after receiving the request. Your physician must complete the expedited certification page of the request form, and you can ask for it at the same time as an expedited internal appeal.
Free
State-regulated plans (insurance bought in Utah or through an employer that buys insurance). Grandfathered plans are not covered by the state rule. Self-funded employer plans use the federal process unless they choose to follow Utah's.
File the Independent Review Request Form with the Insurance Department (mail, email healthappeals.uid@utah.gov, or fax 385-465-6047), along with your insurance card, the denial letter and any physician certifications. If you send it to the insurer by mistake, the insurer must forward it within one business day. UID says the carrier runs the review for some coverage types, so check your denial letter. The 800 number is in-state only; the health consumer line is 801-957-9280.
Who to contact
- Utah Insurance Department
- External review information and forms
- Consumer help line: 800-439-3805
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 Utah?
Within 180 calendar days after receiving a notice of a final adverse benefit determination
Can I get a fast external review in Utah?
Available if waiting could seriously jeopardize your life, health or ability to regain maximum function, would cause severe pain, or involves an emergency stay before discharge. The IRO must decide no later than 72 hours after receiving the request. Your physician must complete the expedited certification page of the request form, and you can ask for it at the same time as an expedited internal appeal.
Does external review cost anything in Utah?
Free
Do Utah’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
- Utah Admin. Code R590-261-8 (LII)
A claimant has 180 calendar days after receiving a notice of a final adverse benefit determination to file a request with the commissioner for an independent review.
- Utah Insurance Department: R590-261 amendment (2025)
may not require the claimant to pay a fee for requesting the independent review
- Utah Insurance Department: Independent Review
Print and complete the Independent Review Request Form.
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.