Guides ยท Last reviewed October 28, 2026
External review: how to ask an independent reviewer to decide your insurance denial
An external review either upholds your insurer's decision or decides in your favor. You file a written request within 4 months of the denial notice, and your insurer is required by law to accept the external reviewer's decision.
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The key facts (from HealthCare.gov)
- Deadline: a written request within 4 months after the date you receive the denial notice.
- Who can file: you, or a representative you appoint, such as your doctor.
- Binding: the insurer must accept the reviewer's decision.
- Cost: no charge under the HHS-administered process. In other processes, the charge can't be more than $25 per external review.
- Urgent cases: an expedited review decision is due as soon as possible, no later than 72 hours from receipt, or sooner if medical urgency requires it.
How to request it
Which process applies depends on your plan. Your Explanation of Benefits or your final internal appeal denial tells you where to send the request. If your plan uses the HHS-administered process, HealthCare.gov lists these options:
- The secure online portal at maximusferp.my.site.com/FERP
- Call 1-888-866-6205 to get a request form, then fax it to 1-888-866-6190
- Mail the form to MAXIMUS Federal Services, 3750 Monroe Avenue, Suite 705, Pittsford, NY 14534
- Email ferp@maximus.com
If your plan uses a state process, use the contact information in your denial letter.
What to include
- The denial letter and your claim or reference number
- Your internal appeal and the insurer's final response
- A letter from your doctor explaining why the care is needed
- Medical records and any new evidence
Copy everything and keep proof of when you sent it.
Before and after
Start with the insurer's own appeal. See how to appeal a health insurance denial. Medicare uses a different process: see how to appeal a Medicare denial.
Common questions
How long do I have to request an external review?
HealthCare.gov says the written request is due within 4 months after the date you receive the denial notice.
Does the insurer have to follow the decision?
Yes. HealthCare.gov says your insurer is required by law to accept the external reviewer's decision.
Is there a faster option for urgent care?
Yes. An expedited external review decision is due as soon as possible and no later than 72 hours from receipt, or sooner if the medical urgency requires it.
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Sources
Rules can differ for some plans, such as those that use a state process. Billmira is a self-help information tool, not a law firm, and this isn't legal, tax, or medical advice. Rules change and plans differ; check the official sources above and your own documents.