Arkansas program
Appeal a denial outside the plan (Arkansas external review)
An independent reviewer can reconsider certain health-plan denials through the Arkansas Insurance Department.
What it is
An independent reviewer can reconsider certain health-plan denials through the Arkansas Insurance Department.
A final refusal from the insurer is not always the last word. Arkansas's external review puts the decision in front of a doctor outside the plan, and the answer binds the plan. The plan's own appeal usually comes first; an urgent case can skip ahead, and so can a case where the insurer missed its own deadlines.
Eligibility rules
- This route covers eligible medical-judgment or experimental-treatment denials by covered health carriers. It does not cover every unpaid bill.
- Medicaid/PASSE, Medicare, federal employee coverage, TRICARE and listed limited-benefit policies are outside this procedure.
- An insured public-employer policy can use the applicable carrier process. A self-funded public or church plan needs its own contract and regulator checked. A private self-funded ERISA plan generally follows a federal route.
- Internal appeals normally come first. Qualifying urgency, insurer waiver or failure to complete required internal steps can allow earlier external review.
What you get
- An outside decision within 45 days, or within 72 hours for an urgent review.
Coverage and limits
- The Arkansas Insurance Department assigns an independent review organization. The treating doctor supplies the medical case for urgency.
If you decide to apply
- With your social worker, ask Arkansas Insurance Department whether review fits the plan and denial, and which form and deadline apply.
- Gather the denial letters and ask the oncology office for supporting medical records.
- For an urgent review, ask the doctor to complete the physician certification.
Arkansas Insurance Department, 1-800-852-5494 or 501-371-2600 · Official page ↗
After you apply
- The standard independent-review decision is due within 45 days after receiving the request. Expedited review is due within 72 hours.
- The request deadline is four calendar months after you receive the qualifying adverse or final adverse notice. The date printed on a letter is not automatically the receipt date.
Good to know
The four months run from the day you receive the denial letter, so keep the envelope or the email. Four calendar months is a little longer than 120 days.
Other details
- Requests go to insurance.externalreview@arkansas.gov; help is at 1-800-852-5494 or 501-371-2600.
Official sources
“If our plan refuses treatment, would Arkansas's outside review apply? What would it add to an internal appeal, and could you help us prepare the request if it is the right route?”
Why I’m asking: I want to understand the available review and its deadlines if a treatment claim is denied.
More background and detailed requirements
Additional program information and published rules
Who does what
The three parts, side by side. The agency decides; nobody on this page does.
You
File within four months of the denial notice and send the letters with it.
Your social worker
The social worker gathers the records; the Insurance Department consumer line walks you through the form.
The care team
Signs the physician certification for an urgent review and writes the medical-necessity letter.
- Who decides
- An independent review organization assigned by the Arkansas Insurance Department.
- Ask the care team
- “The plan denied this. Can you write the medical-necessity letter and sign the certification for an urgent external review?”
How to apply
First step: Call 1-800-852-5494 and ask for the External Review Request Form; send the denial letters with it.
- Keep every denial letter and note the date on it.
- Ask the oncologist for a medical-necessity letter the same week.
- For an urgent refusal, ask for the physician certification so the review runs in 72 hours.
Official application / program page ↗
Where it starts: Ask the Insurance Department for the External Review Request Form; for an urgent case, the Physician Certification of Expedited External Review goes with it. Email listed: insurance.externalreview@arkansas.gov. Phone 1-800-852-5494 or 1-501-371-2600.
What to gather
- The final denial letter
- The plan's internal appeal decision
- The oncologist's letter
How long: 45 days, or 72 hours on the urgent route.
Clock: Request external review within four calendar months after receiving the qualifying adverse or final adverse notice; do not substitute 120 days.
What a yes looks like
A written decision overturning the refusal, which the plan has to follow.
What a no looks like, and the next move
Ask the oncologist about an alternative and the Insurance Department about a complaint.
Watch out
- Four calendar months run from receipt of the qualifying notice, not a fixed 120 days.
- A self-funded employer plan uses the federal route instead.
- Public and church plan review routes require their own plan document and regulator check.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 11, 2026.
What it is worth
File within four months of the denial; a decision in 45 days, or 72 hours when urgent. Help: 1-800-852-5494.
- $4 — Filing window after the denial notice
- $45 — Standard decision
- $72 — Expedited decision
Legal protection: An independent review of a refusal, outside the plan · An expedited route where the child's condition requires it
What it costs the family: None.
The eligibility facts, as published
- Plan type
- Health carriers subject to Arkansas insurance law; some policy types are excluded by the rule
- Self funded
- not covered: a private-employer self-funded plan uses the federal process
- Public plans
- An insured public-employer policy can use the applicable carrier process. A self-funded public or church plan needs its contract and regulator checked; funding type alone does not establish ERISA jurisdiction.
- Deadline
- Four calendar months after receiving the adverse or final adverse determination
The trap: The request window is four calendar months after receipt of the qualifying notice, not a fixed 120 days or necessarily the letter date.
Where I read this
- External review, 23 CAR Part 117 — Arkansas Insurance Department, read September 10, 2026
- External review — Arkansas Insurance Department, read September 10, 2026