Your rights vary by state.
States have their own appeal windows, external review programs, and consumer protections layered on top of federal law. Here's what we know for the states we currently work in.
California
California has some of the strongest patient appeal rights in the country, administered jointly by the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI).
Texas
Texas administers appeals through the Texas Department of Insurance (TDI) for most commercial plans, with separate routes for ERISA self-funded employer plans.
Florida
Florida's appeal landscape is governed by the Office of Insurance Regulation (OIR) for commercial insurance and the Agency for Health Care Administration (AHCA) for managed-care issues.
New York
New York has strong consumer protections administered by the Department of Financial Services (DFS), including a robust external appeal program.
Alabama
Alabama administers commercial appeals through the Alabama Department of Insurance and follows the federal ACA framework for external review.
Alaska
Alaska's Division of Insurance regulates commercial appeals and oversees a state external-review process for ACA-compliant plans.
Arizona
The Arizona Department of Insurance and Financial Institutions oversees state-regulated commercial appeals and administers a state external-review program.
Arkansas
The Arkansas Insurance Department regulates state-licensed commercial plans and administers external review under state law.
Colorado
The Colorado Division of Insurance enforces strong patient-protection rules, including network-adequacy standards and a state external-review process.
Connecticut
Connecticut's Insurance Department oversees a robust state external-review program and active consumer assistance through the Office of the Healthcare Advocate (OHA).
Delaware
The Delaware Department of Insurance regulates state-licensed commercial plans and administers external review under Delaware law.
District of Columbia
The DC Department of Insurance, Securities and Banking (DISB) regulates DC-licensed commercial plans and administers external review for residents.
Georgia
The Georgia Office of Insurance and Safety Fire Commissioner oversees state-licensed commercial appeals and administers external review.
Hawaii
The Hawaii Insurance Division regulates state-licensed commercial plans and oversees external review. Hawaii's Prepaid Health Care Act adds employer-based coverage protections.
Idaho
The Idaho Department of Insurance regulates state-licensed commercial plans and administers external review for residents.
Illinois
The Illinois Department of Insurance regulates state-licensed commercial appeals; Illinois has expansive mental health parity enforcement under state law.
Indiana
The Indiana Department of Insurance regulates state-licensed commercial plans and administers external review under state law.
Iowa
The Iowa Insurance Division regulates state-licensed commercial appeals and administers external review.
Kansas
The Kansas Insurance Department regulates state-licensed commercial appeals and oversees external review for residents.
Kentucky
The Kentucky Department of Insurance regulates state-licensed commercial appeals and administers an external review program.
Louisiana
The Louisiana Department of Insurance regulates state-licensed commercial appeals and oversees external review for residents.
Maine
The Maine Bureau of Insurance regulates state-licensed commercial appeals and administers an active external review program with strong consumer protections.
Maryland
The Maryland Insurance Administration regulates state-licensed commercial appeals and operates a robust state external-review program.
Massachusetts
The Massachusetts Division of Insurance and the Office of Patient Protection (OPP) at the Health Policy Commission jointly oversee appeal rights; OPP administers external review.
Michigan
The Michigan Department of Insurance and Financial Services (DIFS) regulates state-licensed commercial appeals and administers external review through the Patient's Right to Independent Review Act (PRIRA).
Minnesota
The Minnesota Department of Commerce regulates state-licensed commercial appeals and oversees external review under state law.
Mississippi
The Mississippi Insurance Department regulates state-licensed commercial appeals and administers external review for residents.
Missouri
The Missouri Department of Commerce and Insurance regulates state-licensed commercial appeals and administers external review under state law.
Montana
The Montana Commissioner of Securities and Insurance regulates state-licensed commercial appeals and administers external review for residents.
Nebraska
The Nebraska Department of Insurance regulates state-licensed commercial appeals and oversees external review.
Nevada
The Nevada Division of Insurance regulates state-licensed commercial appeals and administers external review under state law.
New Hampshire
The New Hampshire Insurance Department regulates state-licensed commercial appeals and operates an external review program with strong consumer protections.
New Jersey
The New Jersey Department of Banking and Insurance regulates state-licensed commercial appeals; New Jersey's Independent Health Care Appeals Program (IHCAP) is administered through state-certified IROs.
New Mexico
The New Mexico Office of Superintendent of Insurance (OSI) regulates state-licensed commercial appeals and administers external review.
North Carolina
The North Carolina Department of Insurance regulates state-licensed commercial appeals; the Smart NC program offers free consumer assistance for appeals.
North Dakota
The North Dakota Insurance Department regulates state-licensed commercial appeals and oversees external review for residents.
Ohio
The Ohio Department of Insurance regulates state-licensed commercial appeals and administers external review under state law.
Oklahoma
The Oklahoma Insurance Department regulates state-licensed commercial appeals and oversees external review for residents.
Oregon
The Oregon Division of Financial Regulation regulates state-licensed commercial appeals and oversees an active external review program.
Pennsylvania
The Pennsylvania Insurance Department regulates state-licensed commercial appeals and operates an external review program under Act 146 of 2020.
Rhode Island
The Rhode Island Department of Business Regulation, Insurance Division regulates state-licensed commercial appeals and oversees external review.
South Carolina
The South Carolina Department of Insurance regulates state-licensed commercial appeals and oversees external review for residents.
South Dakota
The South Dakota Division of Insurance regulates state-licensed commercial appeals and administers external review for residents.
Tennessee
The Tennessee Department of Commerce and Insurance regulates state-licensed commercial appeals and administers external review under state law.
Utah
The Utah Insurance Department regulates state-licensed commercial appeals and administers external review for residents.
Vermont
The Vermont Department of Financial Regulation, Insurance Division regulates state-licensed commercial appeals and oversees an external review program with strong consumer protections.
Virginia
The Virginia State Corporation Commission's Bureau of Insurance regulates state-licensed commercial appeals and administers external review.
Washington
The Washington Office of the Insurance Commissioner (OIC) regulates state-licensed commercial appeals and operates an active external review program with broad consumer protections.
West Virginia
The West Virginia Offices of the Insurance Commissioner regulate state-licensed commercial appeals and administer external review.
Wisconsin
The Wisconsin Office of the Commissioner of Insurance (OCI) regulates state-licensed commercial appeals and oversees external review.
Wyoming
The Wyoming Department of Insurance regulates state-licensed commercial appeals and oversees external review for residents.
More states added regularly. Don't see yours? Start Your Appeal and we'll work it under the relevant rules.