Indiana program
An outside review of an insurance denial (Indiana external review)
An independent reviewer can examine an eligible treatment denial from an Indiana-regulated insurance plan.
What it is
An independent reviewer can examine an eligible treatment denial from an Indiana-regulated insurance plan.
A final refusal from the insurer is not always the last word. After the plan's own appeal, the request goes to the insurer, which has to hand it to a certified reviewer chosen in rotation. The Department of Insurance at 800-622-4461 confirms the form and deadline.
Eligibility rules
- Indiana-regulated plans use the state external grievance process.
- The state route is for plans an insurer sells in Indiana. A plan the employer funds itself uses a federal route, and state and school plans follow their own handbook; one question to HR settles which you have.
What you get
- An outside review without a fee to the family.
- An independent reviewer selected in rotation from Indiana's certified list, with safeguards against conflicts of interest.
What the help includes
- The insurer selects an independent review organization in rotation from Indiana's certified list; the reviewer must meet independence and conflict-of-interest rules.
- The oncologist's explanation can address why the proposed alternative does not meet the child's needs.
If you decide to apply
- Ask the plan for the written denial and internal appeal instructions.
- Ask the oncologist for a letter explaining the treatment need and any urgency.
- Work with your social worker and insurer on its request form, filing destination and deadline.
Indiana Department of Insurance, 800-622-4461 · Official page ↗
After you ask
- For eligible Indiana external review, the written request goes to the insurer within 120 days after notice of the appeal decision. A Department of Insurance complaint does not replace or preserve that request.
- Ordinary independent review is completed within 15 business days after filing. Expedited review is completed as quickly as the condition requires, no later than 72 hours.
- Ordinary internal-appeal exhaustion applies, with exceptions for waiver, failures in the required internal process and qualifying urgency. The clinician and insurer can identify whether review can start sooner. Financial disagreement alone does not establish medical urgency.
- The insurer's notice provides its procedure, form and destination. The Department of Insurance can assist at 800-622-4461 or 317-232-2396.
Good to know
If the employer pays its own claims, the federal route applies instead. A government or church plan follows its own rules; ask its administrator.
Other details
- Your answers here do not settle that a denial has occurred or which regulator controls your plan.
- A Medicaid denial has a separate health-plan and state appeal route.
Official sources
“If treatment is denied, could an outside review help us? What deadlines and drawbacks should we understand, and could you help choose the right route and prepare the request if needed?”
Why I’m asking: I want to know how to challenge a treatment denial without losing the right deadline.
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
For eligible Indiana external review, the written request goes to the insurer within 120 days after notice of the appeal decision. A Department of Insurance complaint does not replace or preserve that request. Ordinary internal-appeal exhaustion applies, with exceptions for waiver, failures in the required internal process and qualifying urgency. The clinician and insurer can identify whether review can start sooner. Financial disagreement alone does not establish medical urgency.
Your social worker
The plan issues the written denial and the appeal route.
The care team
The oncologist writes why the treatment is needed and why the alternative is not.
- Who decides
- The insurer selects an independent review organization in rotation from Indiana's certified list; the reviewer must meet independence and conflict-of-interest rules.
- Ask your social worker
- “The plan denied this. Can we get the written denial with the appeal deadline, and a letter from the oncologist for an external review?”
How to apply
First step: For eligible Indiana external review, the written request goes to the insurer within 120 days after notice of the appeal decision. A Department of Insurance complaint does not replace or preserve that request.
- Ask the plan for the denial in writing with the appeal deadline.
- The insurer's denial notice identifies the external-review form and destination; DOI can assist but a complaint is separate.
- Ask the oncology team for a letter saying why the treatment is needed now.
Official application / program page ↗
Where it starts: For eligible Indiana external review, the written request goes to the insurer within 120 days after notice of the appeal decision. A Department of Insurance complaint does not replace or preserve that request. Ordinary independent review is completed within 15 business days after filing. Expedited review is completed as quickly as the condition requires, no later than 72 hours. Ordinary internal-appeal exhaustion applies, with exceptions for waiver, failures in the required internal process and qualifying urgency. The clinician and insurer can identify whether review can start sooner. Financial disagreement alone does not establish medical urgency. The insurer's notice provides its procedure, form and destination. The Department of Insurance can assist at 800-622-4461 or 317-232-2396.
What to gather
- The written denial
- The internal appeal decision
- The oncologist's letter
- The plan booklet
How long: Ordinary independent review is completed within 15 business days after filing. Expedited review is completed as quickly as the condition requires, no later than 72 hours.
What a yes looks like
A decision from the independent reviewer that the plan has to follow.
What a no looks like, and the next move
Ask on what ground it was refused, and whether an expedited route exists for urgent care.
Watch out
- For eligible Indiana external review, the written request goes to the insurer within 120 days after notice of the appeal decision. A Department of Insurance complaint does not replace or preserve that request.
- A private-employer self-funded plan uses the federal route, not this one.
- Whether the route reaches a state-employee, teacher or city plan is unsettled. Ask your administrator which appeal route applies.
Dates that change this
2026-09-10: For eligible Indiana external review, the written request goes to the insurer within 120 days after notice of the appeal decision. A Department of Insurance complaint does not replace or preserve that request. Ordinary independent review is completed within 15 business days after filing. Expedited review is completed as quickly as the condition requires, no later than 72 hours.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 11, 2026.
What it is worth
An independent reviewer selected in rotation from Indiana's certified list, with safeguards against conflicts of interest.
Legal protection: Grievance and appeal rights for people in a health maintenance organisation contract or an accident and sickness policy · An independent reviewer selected in rotation from Indiana's certified list, with safeguards against conflicts of interest.
What it costs the family: None to the family.
The eligibility facts, as published
- Plan type
- state-regulated plans; a private-employer self-funded plan uses the federal route, and the reach into state-employee, teacher and municipal plans was NOT FOUND
The trap: For eligible Indiana external review, the written request goes to the insurer within 120 days after notice of the appeal decision. A Department of Insurance complaint does not replace or preserve that request. Ordinary independent review is completed within 15 business days after filing. Expedited review is completed as quickly as the condition requires, no later than 72 hours.
Where I read this
- Internal and external grievance procedures — Indiana Department of Insurance, read September 10, 2026
- Independent review organization renewal registration — Indiana Department of Insurance, read September 10, 2026
- House Enrolled Act 1003 (2025) — Indiana General Assembly, read September 10, 2026