Illinois health insurance appeal rights

Internal appeal in Illinois

Under the ACA, you generally have 180 days from the date you receive the denial notice to file an internal appeal. The insurer must decide the appeal within 30 days for pre-service claims, 60 days for post-service claims, and 72 hours for expedited appeals where waiting could jeopardize your health.

The Illinois Department of Insurance oversees consumer protections for Illinois health-insurance plans. If your insurer fails to decide the appeal within the required timeline or refuses to consider your appeal, you can file a complaint at https://idoi.illinois.gov/.

External review in Illinois

Illinois runs the External Independent Review for external review of denied health-insurance claims. After your internal appeal is denied, you have 120 days to request external review. The independent reviewer is not affiliated with your insurer, and the decision is binding under federal and state law.

You can request external review at https://idoi.illinois.gov/consumers/healthinsuranceissues/externalreview.html.

Illinois Health Carrier External Review Act governs the program.

How InsureDefense supports Illinois appeals

Our standard tiers prepare your internal appeal with citations to the relevant Illinois appeal-rights provisions. After internal appeal, our External Review Pack ($199) prepares the state-specific submission packet for the External Independent Review.

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