Colorado program
An outside doctor reviews the denial
An independent reviewer can reconsider certain insurance denials, with faster routes for qualifying urgent cases.
What it is
An independent reviewer can reconsider certain insurance denials, with faster routes for qualifying urgent cases.
An insurer's final internal denial is not always the end. Colorado's outside review applies to plans its insurance regulator covers; a plan where the employer pays its own claims uses a federal route instead. One question to HR settles which.
Eligibility rules
- The plan must fall under the Colorado insurance commissioner's jurisdiction.
- An internal appeal usually comes first. Urgent cases, deemed exhaustion and other legal exceptions can allow a different route; an optional second internal appeal is not always required.
What you get
- Independent review paid for by the insurer.
- A faster review when the request meets the urgent standard.
What the help includes
- An ordinary decision is due within 45 days after the reviewer receives the request. An expedited decision is due within 72 hours.
If you decide to apply
- Ask the insurer for its external-review request process and keep the internal denial notice.
- Ask the oncology team to explain why the treatment is needed and whether waiting would be dangerous.
Colorado Division of Insurance: 303-894-7499; outside Denver: 800-930-3745 · Official page ↗
After you ask
- The state regulator assigns an independent reviewer. The insurer pays the review cost.
- The reviewer issues a written decision that the insurer must follow.
Good to know
You have four months after the internal appeal denial to ask. When waiting would harm your child, the urgent version can run at the same time as the plan's own appeal.
Other details
- Your answers here do not settle plan regulation or whether a denial exists. HR and the denial notice can identify the correct process.
- The denial reason and plan rules decide whether an external review is available. The oncology team can document why waiting would endanger health or recovery, and the social worker can help ask about expedited review without waiting for an optional second internal appeal. The Division of Insurance can identify the state route; a private self-funded employer plan generally uses a federal route instead.
“If our insurer denies needed treatment, would an outside review help, and what are its limits compared with another appeal? Could you help us choose the right process and gather the medical explanation?”
Why I’m asking: I want a fair review of needed care without losing time on a process that does not apply to our plan.
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
Ask in writing within four months and say if it is urgent.
Your social worker
The insurer must offer the process and pay for it.
The care team
The oncologist writes why the treatment is needed, and whether waiting is dangerous.
- Who decides
- An independent reviewer named by the state regulator.
- Ask the agency
- “I am requesting independent external review of this denial under Colorado law, and I am asking for it to be expedited because my child is in active cancer treatment.”
How to apply
First step: Write to the insurer asking for independent external review, and copy the state regulator.
- Ask for external review in writing within four months of the internal denial.
- Ask the oncology team to say in writing that the treatment is urgent, which shortens the clock to 72 hours.
Where it starts: Ask the insurer for external review in writing, and call the regulator on 303-894-7499 if it stalls.
What to gather
- The internal denial letter and its date
- The oncologist's letter of medical necessity
How long: 45 days, or at most 72 hours when expedited.
What a yes looks like
A written determination the insurer must follow.
What a no looks like, and the next move
Ask the regulator on 303-894-7499 what other route is open.
Watch out
- The clock is four months from the internal denial notice.
- Say in writing that it is urgent, which shortens the decision to 72 hours.
- A self-funded plan usually uses the federal route instead. Ask HR which kind of plan it is.
If they say no, quote this: Colorado Revised Statutes 10-16-113.5: the request must be made within four months of the internal-appeal denial, and the carrier pays the cost.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 11, 2026.
What it is worth
An independent review of a denial within 45 days, or 72 hours when it is urgent, paid for by the insurer.
- $4 — Deadline to request the review after the internal-appeal denial
- $45 — Ordinary determination after the reviewer receives the request
- $72 — Expedited determination
Legal protection: Carriers must make the process available and pay for it
What it costs the family: Nothing.
The eligibility facts, as published
- Plan types
- Health benefit plans subject to the insurance commissioner's jurisdiction. Reach into self-funded, state-employee, teacher and municipal plans was not established.
- Trigger
- An internal appeal of an adverse determination has been denied
The trap: The clock is four months from the notice of the internal-appeal denial, and it is easy to lose while the team argues with the plan. Ask the oncology team to mark that date on the chart.
Where I read this
- Colorado Revised Statutes 2026, Title 10 - Insurance — Colorado General Assembly, Office of Legislative Legal Services, read September 10, 2026
- Colorado Division of Insurance — Colorado Department of Regulatory Agencies, read September 10, 2026