Georgia health insurance appeal rights

Deadline details depend on the applicable plan and actual notice. Check the source-verified appeal directory and official instructions.

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How appeals work in Georgia

Georgia gives you a two-step path after a denial. First you appeal to your health plan (the internal appeal). If the plan still says no, you can request an independent external review under Georgia’s Patient’s Right to Independent Review Act. The Georgia Office of Commissioner of Insurance and Safety Fire assigns an Independent Review Organization — a reviewer outside your insurer — and your plan is required by law to accept the decision.

External review generally applies when a plan denies care as not medically necessary, experimental or investigational, or otherwise clinically inappropriate. (Self-funded employer plans governed by federal ERISA rules follow the federal external review process instead — your denial letter will say which applies.)

Step 1 — your internal appeal

Deadline details depend on the applicable plan and actual notice. Check the source-verified appeal directory and official instructions.

Step 2 — request an external review

Deadline details depend on the applicable plan and actual notice. Check the source-verified appeal directory and official instructions.

Where to file and get help

• Request a review or file a complaint — through the Georgia Office of Commissioner of Insurance and Safety Fire.
• Consumer services — 1-404-656-2070 (Atlanta metro) or 1-800-656-2298 (outside metro).

Putting it together

Read the denial, file your internal appeal, then request the independent external review — and mind the short deadline. Our step-by-step guide covers each stage, external review explains independent review generally, and our appeal-deadline guide helps you track your dates. In another state? See Florida or Texas appeal rights.