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State guide

Alabama

Pick the kind of plan you have to see who to call first. Alabama can only help with plans it regulates.

On this page 8

Which plan do you have? Who to call first, by coverage

  • Your employer pays claims itself

    Alabama usually cannot help with these plans. Call the Employee Benefits Security Administration.

    Call 1-866-444-3272

  • Insurance you buy, or an employer plan bought from an insurer

    Call Alabama Department of Insurance. See the at-a-glance box.

    Call 334-241-4141

  • Medicaid or children's coverage

    Call the number on your notice and ask to appeal, and to keep services going while you appeal. The hearing deadline is under Medicaid in Alabama.

    Medicaid in Alabama

  • Medicare

    Alabama State Health Insurance Assistance Program (SHIP), run by the Alabama Department of Senior Services gives free counseling. Or call 1-800-MEDICARE.

    Call 1-800-243-5463 1-800-633-4227

The short version for Alabama

Alabama is one of five states that does not run its own external review program, so an independent review of a denial goes through the federal process overseen by the U.S. Department of Health and Human Services (HHS) instead of the state. Alabama has no federally listed Consumer Assistance Program, so the main state help is the Alabama Department of Insurance Consumer Services Division, which takes complaints but cannot help with self-funded employer plans. A state law that took effect October 1, 2026 requires a licensed physician or other qualified health professional, not artificial intelligence alone, to make any decision to deny, delay or change a prior authorization request for medical necessity.

At a glance: independent review for plans Alabama regulates

This box is for insurance you buy, or an employer plan bought from an insurer. It is not for Medicaid, Medicare or a plan your employer funds itself.

Main regulator
Alabama Department of Insurance · 334-241-4141 or 1-800-433-3966 (Consumer Services)
Independent review
The federal process run for the Department of Health and Human Services (Federal external review (the HHS-Administered Federal External Review Process, or an independent review organization hired by your insurer))
Deadline to request it
4 months after the date you receive the denial notice or the final internal appeal denial
Cost
None if your insurer uses the HHS-administered process. If your insurer contracts with an independent review organization instead, you may be charged, but no more than $25 per external review.
Decision time
As soon as possible, and no later than 45 days after the request is received; fast track: As fast as your medical condition requires, and no later than 72 hours after the request is received

Your own notice states the deadline and process for your plan, and controls if it differs. Plans your state does not regulate (for example job-based plans the employer funds itself) follow federal rules; see who regulates your plan.

Who regulates health plans

Alabama's insurance department does not publish a way to tell from your insurance card. It does say that if your plan is self-funded, your employer administers it and you need to contact your employer for help, so ask your employer or benefits office whether your plan is self-funded or fully insured.

Independent (external) review

Process
The federal process run for the Department of Health and Human Services. Run by MAXIMUS Federal Services, the contractor for the U.S. Department of Health and Human Services (HHS), for insurers that use the HHS-administered process. An insurer may instead contract with accredited independent review organizations.
Where you file
federal
How
Read your final denial letter first: it must name who handles your external review. If your plan uses the HHS-administered process, file online at externalappeal.cms.gov, or call 1-888-866-6205 to ask for a request form and then fax it to 1-888-866-6190, mail it to MAXIMUS Federal Services at the address printed on the form, or email ferp@maximus.com. If your insurer uses its own contracted independent review organization, follow the instructions in the denial letter.
Which denials qualify
Denials that involve medical judgment (medical necessity, appropriateness, health care setting, level of care, or effectiveness of a covered benefit), denials because a treatment is called experimental or investigational, and cancellations of coverage back to an earlier date (rescissions). The federal request form also lists certain surprise billing (No Surprises Act) disputes about your cost sharing.
Appeal to the plan first?
Yes, in most cases you must finish your plan's internal appeal first. Exception: in an urgent situation, where waiting would seriously jeopardize your life, health or ability to regain maximum function, you can ask for an expedited external review after the first denial as long as you have also asked for an expedited internal appeal.

Official page Request form

General rules and what to send: how external review works, how to request it.

Free help in Alabama

Medicare and Medicaid in Alabama

Medicare counseling
Alabama State Health Insurance Assistance Program (SHIP), run by the Alabama Department of Senior Services · 1-800-243-5463 . Free help with Medicare appeals.
Medicaid agency
Alabama Medicaid Agency (Alabama Medicaid)
Fair hearing deadline
Your request must be received by Medicaid within 60 days from the date the notice of action is mailed. Late requests are not accepted. Your notice states the deadline that applies to you.
Good to know
Under rules effective July 13, 2026 you can ask for a fair hearing by mail (Alabama Medicaid Agency, Attn: Fair Hearings Coordinator, 501 Dexter Avenue, Post Office Box 5624, Montgomery, Alabama 36103-5624, or your district office), by email to FairHearings@medicaid.alabama.gov, or by phone through your case worker or the Fair Hearings Coordinator at 334-353-5210 (voicemail requests are not accepted). If Medicaid is ending your eligibility and your request is received within 10 days of the date of the notice, benefits may continue until the hearing is decided, but Medicaid's hearing form warns you may have to repay those benefits if you lose. A decision is normally due within 60 days of your request and no later than 90 days. For general questions call the Recipient Call Center at (800) 362-1504.

Medicaid appeals page How Medicaid appeals work

State laws that can help

  • AI in utilization review. Since October 1, 2026, a health plan that uses artificial intelligence for prior authorization must base the decision on your own medical history and clinical circumstances, and any decision to deny, delay or change a request for medical necessity must be made by a licensed physician or other qualified health professional.

    Alabama Act 2026-589 (Senate Bill 63, 2026 Regular Session)

  • Prior authorization. Utilization review companies must give a decision within two business days of getting the request and all needed information, must decide appeals within 30 days using a physician in the same or a similar specialty, and must let your doctor appeal urgent denials by phone with a decision within 48 hours; companies accredited by the Utilization Review Accreditation Commission are exempt from this section.

    Code of Alabama § 27-3A-5

  • Denial notice. A notice refusing to certify an admission, service or procedure must state the principal reason for the decision and explain how to start an appeal (the same accreditation exemption applies).

    Code of Alabama § 27-3A-5(a)(3)

  • Other. Health insurers must pay or deny a clean claim within 45 calendar days for a paper claim or 30 calendar days for an electronic claim, and must give the reason when denying or holding a claim; overdue claims earn 1.5 percent interest per month.

    Code of Alabama § 27-1-17

  • Other. A health maintenance organization (HMO) must decide a formal complaint within 30 calendar days, or within three working days for an urgent medical necessity denial, and must tell you that you may then appeal to the state complaint committee through the State Health Officer or the Commissioner of Insurance.

    Alabama Administrative Code rule 420-5-6-.08

  • Surprise billing. Alabama has no state surprise billing law that sets out-of-network payment, so the federal No Surprises Act applies and is enforced in Alabama directly by the federal Centers for Medicare & Medicaid Services (CMS), with related denials going to the federal external review process; the federal No Surprises Help Desk is (800) 985-3059.

    CMS letter to Alabama on Consolidated Appropriations Act, 2021 enforcement, December 8, 2021

State laws usually reach only plans your state regulates. They often do not reach job-based plans the employer funds itself.

Sources and what we could not confirm

Read from official pages on . Phone numbers and deadlines change; check the official page before you rely on one.

  1. Affordable Care Act: Working with States to Protect Consumers (State External Appeals Review Processes list) | CMS
  2. HHS-Administered Federal External Review Process for Health Insurance Coverage | CMS
  3. External Review | HealthCare.gov
  4. HHS-Administered Federal External Review Request Form (MAXIMUS Federal Services)
  5. HHS-Administered Federal External Review Process portal (externalappeal.cms.gov redirects here)
  6. Consumer Assistance Program | CMS (lists Alabama as having no Consumer Assistance Program)
  7. Alabama Department of Insurance - Resources for Consumers
  8. Alabama Department of Insurance - File A Consumer Complaint
  9. Alabama Department of Insurance - Contact Us
  10. Alabama Department of Insurance - How to appeal if your health insurance claim is denied (April 4, 2025)
  11. Alabama Department of Insurance - Health Care Reform FAQs (PDF)
  12. Alabama Department of Insurance - Where to Go for Help
  13. Alabama Department of Public Health - Managed Care Compliance
  14. Alabama Administrative Code rule 420-5-6-.08 - Complaint System (health maintenance organizations)
  15. Alabama Administrative Code rule 560-X-3-.03 - Fair Hearing Procedures For Recipients And Providers
  16. Alabama Administrative Code rule 560-X-3-.08 - Fair Hearing Requests Form and Delivery
  17. Alabama Medicaid Form 248 - Fair Hearings (PDF)
  18. Alabama Medicaid - Medicaid Contacts
  19. Medicare & Insurance Counseling (SHIP) - Alabama Department of Senior Services
  20. Alabama | State Health Insurance Assistance Programs (shiphelp.org)
  21. Ask EBSA | U.S. Department of Labor
  22. Contact us - Legal Services Alabama
  23. Older Adult Resources - Legal Services Alabama
  24. Senate Bill 63 (2026 Regular Session), enrolled text - Alabama Legislature
  25. Fiscal Note, Senate Bill 63 (Act 2026-589) as enacted - Alabama Legislature
  26. Code of Alabama § 27-3A-5 - Standards for Utilization Review Agents (Justia)
  27. Code of Alabama § 27-1-17 - Limitation Periods for Payment of Claims (Justia)
  28. CMS letter to Alabama on Consolidated Appropriations Act, 2021 enforcement and dispute resolution (December 8, 2021)
Not confirmed (13)
  • Where to file for independent review. CMS lists Alabama under 'HHS Administered Process/Independent Review Organization Process' without saying which one each insurer chose; no official page lists insurers' elections, so the denial letter is the only way to know whether to file with MAXIMUS or through the insurer's contracted review organization.
  • How to file for independent review. official federal sources disagree on contact details: HealthCare.gov and CMS print 1-888-866-6205 and mailing Suite 705, while the current MAXIMUS request form prints 1-888-975-1080 for questions and mailing Suite 708 (same street address, 3750 Monroe Avenue, Pittsford, NY 14534). The fax 1-888-866-6190 and email ferp@maximus.com match on both.
  • The official independent review page. the Alabama Department of Insurance site has no page explaining external review or naming the federal process; its Health Care Reform FAQs only say an external review by an independent third party exists and give 334-269-3550 and 334-241-4141 for questions. The federal classification comes from CMS only.
  • The independent review request form. the form link contains a version timestamp on the MAXIMUS portal and may change; the externalappeal.cms.gov address redirects to maximusferp.my.site.com, and the portal itself could not be read as text (it loads only with scripts).
  • Published results of independent review. no officially published Alabama overturn rate was found.
  • The state regulators. the Department of Public Health's own Managed Care Compliance page prints (334) 206-5175, but the Department of Insurance 'Where to Go for Help' page lists (334) 206-5300 for 'Department of Public Health (HMO Complaints)'. That Public Health page was last updated September 30, 2021, and an older address (alabamapublichealth.gov/managedcare/) is dead.
  • The state regulators. the department's page links onward to an online form hosted by the National Association of Insurance Commissioners (sbs.naic.org); that form blocked automated loading (HTTP 403), so the department's own complaint page is given instead.
  • The Medicaid fair hearing deadline. the rule (560-X-3-.03, amended effective July 13, 2026) counts 60 days from the date the notice of action is mailed, while Medicaid's Form 248 (dated 08-23) counts 60 days following the effective date of the agency action. The rule is used here.
  • Notes on Medicaid appeals. the rule gives the Fair Hearings Coordinator as 334-353-5210, while the Alabama Medicaid contacts page lists 'Fair Hearings 1-334-242-5741' (the same number as its Office of General Counsel). Form 248 does not mention the email or phone options added in 2026. Whether any managed care plan appeal must come first was not confirmed on an Alabama Medicaid page.
  • The Medicaid fair hearing page. no plain-language Alabama Medicaid web page on fair hearings was found; the link is the official administrative rule, and the agency's own Form 248 PDF is in sources.
  • The state's Medicare counseling program. the state calls it the State Health Insurance Assistance Program; shiphelp.org labels it 'Senior Health Insurance Program (SHIP)'. Phone matches on both.
  • State laws that help. no Alabama step therapy exception law, gold card law or mental health parity enforcement law could be confirmed on an official source (third-party trackers disagree on step therapy), so none is listed. Code sections 27-3A-5 and 27-1-17 were read on Justia (2025 edition) because the official Code of Alabama site could not be read as text; the Act number 2026-589 for Senate Bill 63 comes from the Legislature's fiscal note, not the enrolled bill text.
  • Free consumer help programs. the Alabama Attorney General's consumer office was not listed because its page could not be loaded and nothing confirmed it handles health insurance denials; the Department of Insurance lists it at (334) 242-7335.

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