After No
Urgent help
Menu Close

State guide

Indiana

Pick the kind of plan you have to see who to call first. Indiana 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

    Indiana 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 Indiana Department of Insurance, Consumer Services Division. See the at-a-glance box.

    Call 800-622-4461

  • 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 Indiana.

    Medicaid in Indiana

  • Medicare

    State Health Insurance Assistance Program (SHIP), Indiana Department of Insurance gives free counseling. Or call 1-800-MEDICARE.

    Call 800-452-4800 1-800-633-4227

The short version for Indiana

In Indiana, independent (external) review is requested from your insurer, not from the state, so the insurer picks a certified independent reviewer from a rotating list and pays for it; you have 120 days from the insurer's appeal decision to ask. The Indiana Department of Insurance takes written complaints and is the main state helper, but Indiana has no state consumer advocate that files appeals for you. State law gives you a fast step therapy exception process and, since 2025, a doctor-to-doctor review of prior authorization denials.

At a glance: independent review for plans Indiana 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
Indiana Department of Insurance, Consumer Services Division · 800-622-4461 or 317-232-2395
Independent review
A state process (External grievance review (review by an independent review organization))
Deadline to request it
120 days after you are notified of the insurer's internal appeal decision
Cost
None. By law the insurer pays all costs of the independent review organization.
Decision time
15 business days after the external grievance is filed; fast track: 72 hours after the external grievance is filed (when the standard timeframe would seriously jeopardize life, health or ability to reach and maintain maximum function)

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 Indiana Department of Insurance gives no insurance-card tip. It explains that fully insured plans (bought from an insurance company or health maintenance organization) are state regulated, while self-funded employer plans are overseen by the U.S. Department of Labor, and says that if you do not know your plan type you should review your written plan information or ask your employer or plan administrator. It also says Indiana law generally does not apply to policies issued in other states.

Independent (external) review

Process
A state process. Run by Your insurer, which must assign a different certified independent review organization to each case from the list certified by the Indiana Department of Insurance.
Where you file
insurer
How
After the insurer decides your internal appeal, send a written request for external review to your insurer; the insurer must give you its procedure and forms, and your denial or appeal-decision letter should explain how. The insurer sends your file to the independent reviewer. If you need help, the Indiana Department of Insurance's Consumer Services Division can be reached at 800-622-4461.
Which denials qualify
Insurer appeal decisions you disagree with, including denials based on medical judgment such as not medically necessary or experimental treatment. You may file only one external grievance per insurer appeal resolution.
Appeal to the plan first?
Yes. External review applies to the insurer's appeal resolution, so the insurer's internal grievance and appeal come first.

Official page

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

Free help in Indiana

  • Indiana Department of Insurance, Consumer Services Division

    Answers insurance questions and investigates written complaints against health insurers, which must respond to the department within 20 business days; the federal consumer assistance directory lists this department as the state's help resource.

    Phone: 800-622-4461

  • Indiana Legal Services

    Free civil legal help for people with low income, including public benefits denials and a Senior Law Project for people 60 and older; whether it takes a particular health insurance denial depends on your case and income.

    Phone: 1-844-243-8570

Medicare and Medicaid in Indiana

Medicare counseling
State Health Insurance Assistance Program (SHIP), Indiana Department of Insurance · 800-452-4800 . Free help with Medicare appeals.
Medicaid agency
Indiana Family and Social Services Administration (Indiana Medicaid)
Fair hearing deadline
33 days from the date of the managed care organization's appeal resolution (Indiana rule 405 IAC 10-5-2); for eligibility decisions, 33 days from the date of the notice of action. Your notice states the deadline that applies to you.
Good to know
If you are in the Healthy Indiana Plan, Hoosier Healthwise or Hoosier Care Connect, appeal to your health plan first (plans give 60 calendar days from the denial letter), and you must finish the plan's appeal before asking the state for a hearing. Other Indiana Health Coverage Program members write to the Family and Social Services Administration Office of Administrative Law Proceedings (fssa.appeals@oalp.in.gov, fax 317-232-4412). The Indiana Department of Insurance does not handle Medicaid complaints.

Medicaid appeals page How Medicaid appeals work

State laws that can help

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. Centers for Medicare & Medicaid Services: State External Appeals Review Processes
  2. Centers for Medicare & Medicaid Services: Indiana Health Insurance Consumer Help
  3. Indiana Department of Insurance: Consumer Services
  4. Indiana Department of Insurance: Internal and External Grievance Procedures
  5. Indiana Department of Insurance: Resolving Health Care Insurance Disputes
  6. Indiana Department of Insurance: File an Insurance Company Complaint
  7. Indiana State Health Insurance Assistance Program
  8. Indiana Code chapter 27-8-29, External Review of Grievances (Justia, 2025)
  9. Indiana Code section 27-8-29-13 (Justia, 2025)
  10. Indiana Code section 27-8-29-15 (Justia, 2025)
  11. Indiana Code section 27-8-5-30, Step Therapy Protocol (Justia, 2025)
  12. Indiana Code section 27-1-37.5-17, Peer to Peer Review (Justia, 2025)
  13. Indiana Senate Enrolled Act 480 (2025)
  14. Indiana Medicaid for Members: Member Appeals
  15. Indiana rule 405 IAC 10-5-2, Member appeals; managed care organizations
  16. Indiana Legal Services: What We Do
Not confirmed (11)
  • The official independent review page. Indiana's Department of Insurance has no dedicated external review page that was found; the statute chapter on Justia is cited, and the department's grievance procedures page covers only internal grievances and insurer filing procedures.
  • Independent review. the statute chapter (27-8-29) governs accident and sickness insurance policies; the parallel chapter for health maintenance organizations (27-13-10.1) was not read, so timelines for health maintenance organization members are assumed to match.
  • Whether you must appeal to the plan first. no Indiana page was found on whether an expedited external review can start before internal appeals finish.
  • The independent review request form. each insurer supplies its own form (a CareSource form was seen); no state form exists.
  • Not confirmed. externalReview.decisionsDatabaseUrl and statistics — none found.
  • The Medicaid fair hearing deadline. a Family and Social Services Administration presentation for providers says 60 days after internal appeals for the state fair hearing, while rule 405 IAC 10-5-2 (read on a legal information site, current status not confirmed) says 33 days; the shorter 33 days is shown so no one misses the deadline. Check the notice you receive.
  • The Medicaid fair hearing deadline. the 33 days after a managed care plan appeal cannot be reconciled with the federal rule (42 CFR 438.408(f)(2)), which requires a state to give enrollees no less than 90 and no more than 120 calendar days from the plan's notice of resolution to request a state fair hearing. We could not tell which figure Indiana applies; the shorter 33 days is shown only so no one misses a deadline. Ask the Family and Social Services Administration and read the notice you receive; its date controls.
  • The state regulators. the page was loaded; the online complaint portal it links to was not opened.
  • Not confirmed. stateLaws (gold-card, ai-in-utilization-review, surprise-billing, mental-health-parity, denial-notice) — not researched or confirmed for Indiana.
  • Not confirmed. stateLaws (prior-authorization) — only section 27-1-37.5-17 as shown by Justia (2025) and the enrolled bill text were read; the 2025 law also requires clinical peers to decide denials and appeals and bars prior authorization for the first 12 physical therapy or chiropractic visits, but those parts were read only in the bill text.
  • Free consumer help programs. the Indiana Attorney General's Consumer Protection Division (317-232-6330) was found but no page confirming it handles health insurance denials, so it is not listed. Indiana Legal Services' page does not mention insurance denials specifically.

Sources last checked . Found a mistake? Report it.