Arkansas: fighting a health insurance denial

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

Your employer pays claims itself

Arkansas 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 Arkansas Insurance Department (AID), Consumer Services Division. See the at-a-glance box.

Call 1-800-852-5494
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 Arkansas.

Medicaid in Arkansas
Medicare

Arkansas Senior Health Insurance Information Program (AR SHIIP) gives free counseling. Or call 1-800-MEDICARE.

Call 1-800-224-6330 1-800-633-4227

The short version for Arkansas

Arkansas runs its own external review through the Arkansas Insurance Department (AID): it is free, you file with the state rather than with your insurer, and the independent reviewer's decision is binding on the insurer. There is no separate consumer advocate office for private insurance, so the department's Consumer Services Division is the main place to get help, and it does not publish how often reviews overturn denials. Arkansas also has a strong prior authorization law: only a physician licensed in Arkansas may deny a prior authorization request, and the denial letter must explain the reason in plain terms.

At a glance: independent review for plans Arkansas 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: Arkansas Insurance Department (AID), Consumer Services Division · 1-800-852-5494 (toll free) or 501-371-2640
Independent review: A state process (External review)
Deadline to request it: Within 4 months after you receive the insurer's denial notice
Cost: None. There is no cost to you; the insurer pays the independent review organization.
Decision time: Up to 45 days after the request is received; fast track: 72 hours

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

The Arkansas Insurance Department does not give a tip based on your insurance card. It says the key question is whether your plan is "fully insured" (your employer buys coverage from an insurance company, which the state regulates) or "self-funded" (your employer pays the claims itself, which the state does not regulate for private employers). Ask your employer or plan administrator which one you have. The department also has no authority over federal employee plans, Medicare, Medicaid, health care sharing ministries, or health benefits from nonprofit agricultural membership organizations. Self-funded plans of state and local government employers may be covered, depending on the issue.

Arkansas Insurance Department (AID), Consumer Services Division
Health insurance sold in Arkansas by insurance companies and health maintenance organizations, including individual and Marketplace plans and fully insured employer plans. It does not oversee private employers' self-funded plans, federal employee plans, Medicare or Medicaid.

Phone: 1-800-852-5494 (toll free) or 501-371-2640. File a complaint online

Independent (external) review

Process: A state process. Run by Arkansas Insurance Department (External Review Section of the Consumer Services Division), which assigns each case to an approved independent review organization (IRO).
Where you file: regulator
How: Fill out and sign the Arkansas Insurance Department's External Review Request Form and send it to the department by email to insurance.externalreview@arkansas.gov or by fax to 501-371-2734. If you need a fast (expedited) review, your treating provider must also complete the Physician Certification of Expedited External Review form. Call the External Review Section at 800-852-5494 if you need the form or are not sure your denial qualifies.
Which denials qualify: Denials based on medical necessity, medical appropriateness, health care setting, level of care or effectiveness of care, and denials of treatment as experimental or investigational. There is no minimum dollar amount. Not eligible: services your plan does not cover at all, administrative denials (such as eligibility or unpaid premium), and dental, vision, long-term care, disability income, specified disease, accident-only, hospital indemnity, short-term medical, workers' compensation and auto medical coverage. Medicare, Medicaid and most self-funded plans are outside this process.
Appeal to the plan first?: Yes, in most cases you must finish the insurer's internal appeal first. Exceptions in the state rule: the insurer agrees to waive the requirement; you filed an internal appeal and got no written decision within 30 days (for care not yet received) or 60 days (for care already received); or your case is urgent, in which case you can ask for an expedited external review at the same time as an expedited internal appeal. For an experimental or investigational denial, the same applies if your doctor certifies in writing that the treatment would be much less effective if not started promptly.

Official page Request form

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

Free help in Arkansas

Arkansas Insurance Department, Consumer Services Division
Answers health insurance questions, investigates complaints against insurers, and handles external review requests for state-regulated plans; the federal Centers for Medicare & Medicaid Services lists it as Arkansas's consumer assistance resource.

Phone: 1-800-852-5494
Office of the PASSE Ombudsman, Arkansas Department of Human Services
Helps Medicaid members enrolled in a Provider-led Arkansas Shared Savings Entity (PASSE, the managed care plans for people with complex behavioral health or developmental disability needs) resolve complaints, including questions about appeals.

Phone: 1-844-843-7351
Arkansas Attorney General, Consumer Protection Division
Takes consumer complaints about unfair or misleading practices by health care organizations, including health insurance and medical billing problems, and tries to resolve them informally; it cannot act as your private lawyer.

Phone: (800) 482-8982
Legal Aid of Arkansas
Free civil legal help for low-income Arkansans, including problems with public benefits such as Medicaid and Medicare; it does not list private insurance denials among its case priorities.

Phone: 1-800-952-9243
U.S. Department of Labor, Employee Benefits Security Administration (EBSA)
Handles questions and complaints about self-funded health plans offered by private employers, which the Arkansas Insurance Department cannot regulate; the department points Arkansans to EBSA's Dallas Regional Office at (972) 850-4500.

Phone: (866) 444-3272

Medicare and Medicaid in Arkansas

Medicare counseling: Arkansas Senior Health Insurance Information Program (AR SHIIP) · 1-800-224-6330 or 501-371-2782 . Free help with Medicare appeals.
Medicaid agency: Arkansas Department of Human Services (DHS), Division of Medical Services: Arkansas Medicaid, ARKids First and the Arkansas Health and Opportunity for Me (ARHOME) program
Fair hearing deadline: 30 calendar days from the date on the notice letter. The DHS Office of Appeals and Hearings must receive your request by then or it will be denied. Your notice states the deadline that applies to you.
Good to know: Send the request by email to DHS.Appeals@dhs.arkansas.gov or by mail to the Department of Human Services, Office of Appeals and Hearings, P.O. Box 1437, Slot S101, Little Rock, Arkansas 72203-1437; for questions about an appeal or hearing call 501-682-8622. If you are in a PASSE managed care plan you must appeal to the PASSE first (within 60 calendar days of the date on its denial notice) and can then ask DHS for a state fair hearing within 90 days of the PASSE's appeal decision. To keep services going during a PASSE appeal you must ask within 10 days. For regular Medicaid, a state rule that took effect June 1, 2025 says benefits continue unchanged if you appeal within the notice period, and that the 30 days start 5 days after the notice date, but the DHS appeal page still states a flat 30 calendar days, so treat the date on your letter plus 30 days as the deadline and appeal as early as you can.

Medicaid appeals page How Medicaid appeals work

State laws that can help

External review. You can have a medical necessity or experimental-treatment denial reviewed for free by an independent review organization assigned by the Arkansas Insurance Department, and the decision is binding on the insurer.

Arkansas Insurance Department Rule 76 (Arkansas External Review Regulation), also published as 23 CAR Part 117
Prior authorization. A prior authorization request can be denied only by a physician licensed in Arkansas, your doctor can ask for review by a physician in the same specialty, and if the insurer does not follow the law the requested service is treated as approved.

Prior Authorization Transparency Act, Ark. Code § 23-99-1101 et seq., including §§ 23-99-1111 and 23-99-1116 (Act 1106 of 2015, as amended by Act 815 of 2017)
Denial notice. When a prior authorization is denied, the insurer must send you a written notice that explains the reason in clear and ordinary terms, lists the clinical criteria it relied on and why they apply to you, tells you how to appeal, and gives contact details for filing complaints with the state.

Ark. Code § 23-99-1115(e), added by Act 638 of 2025 (House Bill 1700)
Step therapy. If your plan makes you try other drugs first, you and your prescriber can request an exception that must be granted in listed situations (for example the required drug is likely to harm you, is expected not to work, was already tried, or you are stable on your current drug); the plan must answer within 72 hours, or 24 hours in urgent cases, or the exception is treated as granted.

Ark. Code § 23-79-2101 et seq., especially § 23-79-2104 (Act 97 of 2021); Arkansas Insurance Department Rule 107
Gold card. Health care providers whose prior authorization requests for a particular service are approved at least 90 percent of the time are exempt from prior authorization for that service, which can spare their patients the wait.

Ark. Code § 23-99-1120 et seq. (Act 575 of 2023, amended by Act 511 of 2025)
Mental health parity. A health plan that covers mental illness or substance use disorder treatment must provide those benefits under the same terms and conditions as benefits for other medical conditions.

Arkansas Mental Health Parity Act of 2009, Ark. Code § 23-99-501 et seq., especially § 23-99-506 (Act 1193 of 2009)

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 2026-11-11. Phone numbers and deadlines change; check the official page before you rely on one.

Not confirmed (11)

The official independent review page. the Arkansas Insurance Department page loads its text by script, so a plain page fetch shows an empty page; the questions, answers, form links, email and fax were read from the site's own data feed for that page (insurance.arkansas.gov/wp-json) and should be rechecked in a browser.
How to file for independent review. the current department page gives only an email address and fax number for completed forms. The model form and notice printed in Rule 76 (2012) give a mailing address of 1200 West Third Street and the phone 1-800-282-9134, but the department's contact page now lists 1 Commerce Way, Little Rock, AR 72202 as its address, so no mailing address for external review requests is confirmed.
How long a fast independent review takes. the department's FAQ says 72 hours after the independent review organization receives the medical information from the insurer; Rule 76 says no more than 72 hours after the expedited request is received.
Not confirmed. externalReview.decisionsDatabaseUrl, externalReview.statisticsNote, externalReview.statisticsSourceUrl — no published decisions or overturn statistics were found on the department's site; Rule 76 requires review organizations to report results to the Commissioner only on request.
The state regulators. the Consumer Services page prints 1-800-852-5494 as "Toll Free", the department's Contact page labels the same number "TTY", and the Consumer Protection page gives a different number, 1-855-283-3483, for the Consumer Services Division.
How to tell whether the state regulates your plan. the state gives no insurance-card tip; the text is drawn from the department's FAQ on self-funded versus fully insured plans.
The Medicare counseling program's phone number. shiphelp.org and the federal consumer assistance page list 1-800-224-6330 as the phone number; the department's Contact page labels it "TTY" and lists 501-371-2782 as the phone.
The Medicaid fair hearing deadline. the DHS appeal page states 30 calendar days from the date on the letter for eligibility decisions and case closures but gives no day count for a denied service (a 2021 DHS beneficiary handbook says 30 days). A DHS manual change effective June 1, 2025 says the 30 days begin 5 days after the notice date; the shorter reading is used here.
Notes on Medicaid appeals. the PASSE deadlines (60 days to appeal to the PASSE, 90 days to request a fair hearing, 10 days to keep services) come from the 2023 PASSE Provider Agreement and one plan's 2025 member handbook, not from a DHS consumer page. The 2021 handbook's 10-day rule for keeping regular Medicaid benefits appears to be superseded by the June 2025 rule. How ARHOME members appeal a denial by their private insurance carrier was not confirmed.
State laws that help. summaries are taken from the enacted acts on the Arkansas General Assembly site and from department rules, not from the current official Arkansas Code (which could not be loaded); later amendments may have changed details. These laws generally do not apply to private self-funded employer plans, and the mental health parity act has exclusions (§ 23-99-504) that were not reviewed.
Free consumer help programs. askebsa.dol.gov is the address printed on the federal consumer assistance page for Arkansas; it redirects to a dol.gov page that blocked automated loading, so the destination was not read.

Arkansas

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

Your employer pays claims itself

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

Medicaid or children's coverage

Medicare