Ohio health insurance appeal rights

Denied in Ohio? You have a two-step path: an internal appeal to your plan, then a free external review by an independent organization, overseen by the Ohio Department of Insurance. Here’s how it works and the deadlines to watch.

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How appeals work in Ohio

Ohio 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 external review by an Independent Review Organization (IRO) — a reviewer outside your insurer. The Ohio Department of Insurance (ODI) oversees the process, and the IRO’s decision is binding on both you and your plan.

External review generally applies when a plan denies care as not medically necessary, experimental or investigational, or otherwise clinically inappropriate. Some plans — for example large-employer self-funded plans governed by federal ERISA rules — follow the federal external review process instead; your denial letter will tell you 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

• External review process — see the Ohio Department of Insurance toolkit.
• Ohio Department of Insurance — consumer hotline 1-800-686-1526.

Putting it together

Read the denial, file your internal appeal, then request an external review if you’re turned down. 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 Illinois or Pennsylvania appeal rights.