Written by a parent, not a doctor. Nothing here is medical advice.

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New Hampshire program

A review outside your insurer (external review)

An independent reviewer can reconsider a treatment denial from a health plan covered by New Hampshire law.

What it is

An independent reviewer can reconsider a treatment denial from a health plan covered by New Hampshire law.

A final refusal from the insurer is not always the last word. On an insured plan, the NH Insurance Department sends the denial to a reviewer outside the plan. Medicaid has its own appeal route, even when a child has Medicaid alongside another plan.

Eligibility rules
  • The state route covers state-regulated managed care plans, not every insured product.
  • Self-funded plans run through an administrator and federal employee programs are excluded.
  • Usually the plan’s internal appeal comes first, unless the carrier agrees to skip it, fails the required process, or the urgent-review rules allow both at once. Medicaid, Medicare, federal employee and self-funded plans outside NH’s jurisdiction use different routes. For a state, teacher, municipal or church plan, NHID can check the actual funding and policy rather than relying on the employer’s label.
What you get
  • A decision from a reviewer outside your insurer.
  • A 72-hour decision through the urgent route.
  • A decision that binds the health plan.
What the protection includes
  • The commissioner has seven business days for the preliminary review.
  • After acceptance, you have 20 days to supply extra information. The reviewer then has 20 days after that information is due.
  • These periods run in sequence rather than together.
If you decide to apply
  1. Ask the social worker to help you prepare a written request to the New Hampshire Insurance Department.
  2. Have the denial, any internal appeal decision and the oncology team’s medical explanation ready.

NH Insurance Department Consumer Services · 800-852-3416 or 603-271-2261 · consumerservices@ins.nh.gov. The office can provide the current external-review request form and check the correct route. · Official page ↗

After you ask
  • The outside reviewer can uphold or overturn the denial. The oncology team supplies the clinical case.
  • Standard review has separate stages: preliminary eligibility review within 7 business days, a 10-day chance to complete an incomplete file, 20 days for extra evidence, and a reviewer period of 20 days after that. An urgent decision given orally must be confirmed in writing within 2 business days.
Good to know

The 180-day window runs from the denial or the date an overdue decision was due. Self-funded employer plans use a different route.

Other details
  • The insurer pays the outside review cost; there is no family filing fee under this route. For urgent review, the treating clinician must certify the serious risk from waiting and the request must meet the urgent-review rules. A qualifying decision is due as soon as the condition requires, within 72 hours; urgent review can sometimes run alongside the internal appeal. A past bill alone does not qualify for this faster route.
Official sources
Ask your social worker

“If our plan denies treatment, could an outside review help? What are the limits and deadlines, and could you help us request it?”

Why I’m asking: I want to know who can reconsider a treatment denial and how much time the process allows.

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 in writing within 180 days and ask for the expedited route when it is urgent.

Your social worker

The oncology team writes why the treatment is needed and why waiting would harm the child.

The care team

The doctor supplies the clinical case for the reviewer.

Who decides
An independent review organisation appointed by the state insurance commissioner.
Ask your social worker
“The plan has refused this. Can we file for external review with the state and ask for the 72-hour route?”

How to apply

First step: Ask the plan for the denial in writing, then file with the New Hampshire Insurance Department within 180 days.

  1. Get the denial letter and the internal appeal decision in writing.
  2. File with the insurance commissioner and ask for the expedited route if treatment cannot wait.
  3. Ask the oncology team for the letter saying why the treatment is needed now.

Official application / program page ↗

Where it starts: File in writing with the New Hampshire Insurance Department; the form and current consumer line were not published.

What to gather

  • The denial letter
  • The internal appeal decision
  • The oncology team's letter of medical necessity

How long: Seven business days for the first look, then 20 plus 20 days; 72 hours on the expedited route.

What a yes looks like

The reviewer overturns the plan and the treatment is covered.

What a no looks like, and the next move

The plan is self-funded, so ask the employer about its own final appeal instead.

Watch out

  • Self-funded plans and federal employee programmes are named as outside this route.
  • The clocks run one after another, not together.
  • It applies to managed care plans, not every insured product.

If they say no, quote this: Right to external review: RSA 420-J:5-a, 5-b and 5-c.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

An independent doctor outside the plan reviews the refusal. 180 days to file, 72 hours on the expedited route.

  • $180 — Days to file the request with the commissioner
  • $7 — Business days for the commissioner's preliminary review
  • $20 — Days to submit extra information after the request is accepted
  • $20 — Days for the reviewer's decision after that information is due
  • $72 — Hours for an expedited decision

Legal protection: Review by an organisation outside the plan · An expedited route decided within 72 hours

What it costs the family: None published.

The eligibility facts, as published

Plans
managed care plans regulated by the state; self-funded plans run through an administrator and federal employee programmes are excluded
Filing
in writing to the insurance commissioner within 180 days of the denial or of the date an overdue decision was due
Note
whether state, teacher or municipal plans are reached was not published

The trap: The clocks run in sequence, not all at once: 180 days to file, seven business days for the commissioner's first look, 20 days to put extra information in, then 20 days for the decision. Ask for the expedited route in writing when treatment cannot wait.

Where I read this

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