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

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New Hampshire program

Deadlines for your insurer to answer a treatment request

New Hampshire sets response deadlines for treatment and medicine requests sent to plans covered by state law.

What it is

New Hampshire sets response deadlines for treatment and medicine requests sent to plans covered by state law.

A request for treatment can get stuck while the insurer reviews it. State law gives covered plans deadlines to answer. The clock depends on the request, how it arrives and whether the plan has the information it needs.

Eligibility rules
  • These rules cover state-regulated managed care plans. Self-funded employer plans generally sit outside state insurance law.
  • The electronic treatment deadlines name participating clinicians using the carrier’s designated electronic process.
  • The current utilization-review clocks took effect January 1, 2025.
  • Ask HR one question: does an insurer pay the claims, or does the employer pay them itself? These deadlines reach the first kind. For a state, school or church plan, the Insurance Department can check.
What you get
  • A 72-hour deadline for urgent treatment requests.
  • Seven days for routine electronic treatment requests, or 14 days for other routine requests.
  • A missed deadline can count as approval when the request meets the state rule’s conditions.
What the protection includes
  • A request for a drug on the plan’s formulary has a two-business-day deadline. A non-formulary exception has a 48-hour deadline.
  • The drug clock depends on the prescriber supplying the complete clinical rationale.
  • A continuously enrolled patient cannot be required to fail the same drug more than once.
If you decide to apply
  1. Ask the oncology team when it sent the request and which system it used.
  2. Ask the plan in writing what information is missing and when the response clock started.

Your health plan and oncology team · Official page ↗

After you ask
  • Ask the plan to confirm a missed-deadline approval in writing. A refusal can raise separate appeal rights.
Good to know

The clock starts when the plan has the information it needs. Your team can confirm which deadline applies before relying on it.

Other details
  • When a clinician’s contract ends for reasons other than misconduct, the rule allows 60 days on the old contract terms.
Official sources
Ask your social worker

“How long can our plan take to answer a treatment request, and does the urgent clock apply? Could you help the team get a written answer?”

Why I’m asking: I want to understand when the insurer owes an answer without confusing the date sent with the date its clock starts.

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 when the clock started, then name the deadline.

Your social worker

The oncology team sends the request electronically and tells you the date it went.

The care team

The prescriber supplies the complete clinical rationale, which starts the drug clock.

Who decides
The plan, within the state's deadlines.
Ask your social worker
“When did the plan get everything it needs? Under New Hampshire law the answer is due within seven days, or 72 hours if urgent.”

How to apply

First step: Ask the plan in writing what is still missing and when the clock started, and put the deadline in the letter.

  1. Ask the plan in writing what information is still missing and note the date it was supplied.
  2. Name the deadline in the letter and ask for written confirmation of the decision date.
  3. If the deadline passes, tell the plan the request counts as approved and ask for it in writing.

Official application / program page ↗

Where it starts: Ask the plan in writing which deadline applies and when the clock started.

What to gather

  • The date the request was sent
  • The plan's list of what is still missing
  • The prescriber's clinical rationale

How long: Seven days, 14 days or 72 hours for treatment; two business days or 48 hours for drugs.

What a yes looks like

An authorisation, or a written admission that the deadline passed and the request is approved.

What a no looks like, and the next move

A refusal. Take it to external review with the state.

Watch out

  • The clock starts when the plan has everything it needs, not when the request was sent.
  • The medical clocks are written for the plan's own electronic system.
  • Self-funded plans sit outside state insurance law; ask the employer which kind it is.

If they say no, quote this: Prior authorisation deadlines and deemed approval: RSA 420-J:6, V, VI and VIII.

The numbers and the rules

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

What it is worth

Seven days for a non-urgent electronic request, 14 non-electronic, 72 hours urgent, two business days for a formulary drug and 48 hours for a non-formulary exception. A missed deadline counts as an approval.

  • $7 — Calendar days, non-urgent electronic request
  • $14 — Calendar days, non-urgent request not sent electronically
  • $72 — Hours, urgent request
  • $2 — Business days for a drug already on the formulary
  • $48 — Hours for a non-formulary exception
  • $60 — Days of continued access when a provider's contract ends

Legal protection: A prior authorisation the plan fails to answer within the deadline counts as approved · A plan cannot require failure on the same drug more than once for a continuously enrolled patient · Sixty days of continued access to a provider on the old contract terms when the contract ends for any reason other than misconduct

What it costs the family: None.

The eligibility facts, as published

Plans
managed care plans regulated by the state; the electronic clocks name participating providers using the carrier's designated electronic process
Effective
the current utilization review clocks took effect January 1, 2025
Note
self-funded, state, teacher and municipal applicability was not published

The trap: The clock starts when the plan has everything it needs, not when the request was sent. Ask the plan in writing what is still missing, then start counting and put the date in the letter.

Where I read this

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