State guide
Louisiana
Pick the kind of plan you have to see who to call first. Louisiana can only help with plans it regulates.
Which plan do you have? Who to call first, by coverage
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Your employer pays claims itself
Louisiana usually cannot help with these plans. Call the Employee Benefits Security Administration.
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Insurance you buy, or an employer plan bought from an insurer
Call Louisiana Department of Insurance (LDI). See the at-a-glance box.
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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 Louisiana.
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Medicare
Louisiana Senior Health Information Program (LaSHIP) gives free counseling. Or call 1-800-MEDICARE.
The short version for Louisiana
In Louisiana you ask your own insurance company for the outside review, and the Louisiana Department of Insurance then randomly assigns an independent review organization. The review is free, and if the insurer says you are not eligible you can appeal that to the Commissioner of Insurance. Louisiana has no separate Consumer Assistance Program, so the Department of Insurance is the main place to get help.
At a glance: independent review for plans Louisiana regulates
- Main regulator
- Louisiana Department of Insurance (LDI) · 1-800-259-5300 or (225) 342-5900
- Independent review
- A state process (External review by an independent review organization (IRO))
- Deadline to request it
- 4 months after you receive the notice of final adverse determination (the final denial of your internal appeal)
- Cost
- none (state law says no fee or charge may be put on the covered person; the insurer pays the review organization)
- Decision time
- 45 days (40 days for experimental or investigational treatment reviews); fast track: 72 hours (7 days for an expedited experimental or investigational review)
Who regulates health plans
- Louisiana Department of Insurance (LDI)
Health insurance policies sold in Louisiana (individual plans and fully insured employer plans). It does not handle self-funded employer plans.
Phone: 1-800-259-5300 or (225) 342-5900. File a complaint online
Independent (external) review
- Process
- A state process. Run by Your health insurance company receives the request; the Louisiana Department of Insurance randomly assigns the independent review organization.
- Where you file
- insurer
- How
- Send a written request for external review to your health insurance company, following the instructions in your final denial letter. If the insurer says your request is not eligible, you can appeal that decision to the Commissioner of Insurance (Office of Health Insurance, 225-342-1355).
- Which denials qualify
- Denials involving medical necessity, appropriateness, health care setting, level of care, effectiveness, experimental or investigational treatment, or a rescission (retroactive cancellation) of coverage. Not available when the service is simply not a covered benefit, or for limited benefit plans, short-term plans, workers' compensation, or self-funded employer plans.
- Appeal to the plan first?
- Yes, in most cases you need the insurer's final denial first. In urgent cases you can ask for an expedited external review at the same time as an expedited internal appeal, and the review organization decides whether the internal appeal can be skipped.
Free help in Louisiana
- Louisiana Department of Insurance, Office of Consumer Advocacy and Diversity
Department staff who help people with state-regulated health insurance understand and navigate the appeals process and file complaints against insurers.
Phone: 800-259-5300
Medicare and Medicaid in Louisiana
- Medicare counseling
- Louisiana Senior Health Information Program (LaSHIP) · 1-800-259-5300 . Free help with Medicare appeals.
- Medicaid agency
- Louisiana Department of Health (Louisiana Medicaid; managed care plans are called Healthy Louisiana). Hearings are held by the Division of Administrative Law.
- Fair hearing deadline
- File by the date on your denial notice. The Division of Administrative Law says this is typically within 30 days of the date of the decision notice; if you are in a health plan, you have 120 days from the date of the plan's appeal decision. Your notice states the deadline that applies to you.
- Good to know
- If you are in a Medicaid health plan, appeal to the plan first (within 60 days of its denial notice), then ask for a state fair hearing. Appeal within 10 days of the denial to keep current services while the appeal is reviewed. To ask for a hearing call the Division of Administrative Law at 225-342-5800 or 225-342-0443, fax 225-219-9823, or use its online form. The Department of Health lists Disability Rights Louisiana (800-960-7705) as a group that can assist.
State laws that can help
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External review. The insurer must pay for the independent review, and no fee or other charge can be put on the patient.
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External review. You have four months after a denial notice to ask your insurer for external review, regardless of the dollar amount of the claim, and the insurer must check eligibility within five business days.
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Step therapy. Your prescriber can request an override of a step therapy (fail first) requirement on listed grounds, the plan must answer within 72 hours (24 hours in urgent cases), and if it misses the deadline the override is treated as approved.
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Prior authorization. Insurers must decide prior authorization requests within five business days (two business days for expedited requests), and if they miss the deadline they cannot deny the claim for lack of prior authorization.
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Denial notice. A denial must give all the reasons including the clinical rationale, the credentials of the person who made the decision and a phone number, and your doctor can demand a peer review with a practitioner of the same or similar specialty.
Sources and what we could not confirm
- Understanding Your Healthcare Rights (Louisiana Department of Insurance, Rev. 01/2026)
- Consumer's Guide to Health Insurance (Louisiana Department of Insurance)
- Louisiana Department of Insurance - Consumer IRO Review Appeals
- Louisiana Department of Insurance - File a Complaint Online
- Louisiana Department of Insurance - Senior Health/LaSHIP
- How to Appeal Medicaid (Louisiana Department of Health)
- Division of Administrative Law - Health (Medicaid fair hearings)
- Fair Notice Companion Guide (Louisiana Department of Health)
- CMS: State External Appeals Review Processes
- CMS: Consumer Assistance Program
Not confirmed (6)
- The state regulators. the Department's own 'file a complaint' landing page could not be loaded (blocked); the Consumer Services page and the online complaint form were loaded instead
- How to tell whether the state regulates your plan. no official Louisiana tip found for telling a state-regulated plan from a self-funded one
- The independent review request form. no consumer request form found; requests go to the insurer
- Free consumer help programs. the federal directory lists no Consumer Assistance Program for Louisiana; no statewide legal-aid program for private insurance denials was confirmed
- The state's Medicare counseling program. the federal SHIP directory still calls it the Senior Health Insurance Information Program (SHIIP); the Department of Insurance site now calls it LaSHIP
- State laws that help. a 2026 bill (Senate Bill 246) to limit artificial intelligence in coverage denials did NOT become law (withdrawn May 28, 2026), so it is not listed