State guide

Mississippi

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

On this page 8

Which plan do you have?
Quick facts for independent review
Who regulates health plans
Independent (external) review
Free help in Mississippi
Medicare and Medicaid in Mississippi
State laws that can help
Sources and what we could not confirm

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

Your employer pays claims itself

Mississippi 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 Mississippi Insurance Department (MID). See the at-a-glance box.

Call 800-562-2957
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 Mississippi.

Medicaid in Mississippi
Medicare

Mississippi State Health Insurance Assistance Program (SHIP), Mississippi Department of Human Services, Division of Aging and Adult Services gives free counseling. Or call 1-800-MEDICARE.

Call 844-822-4622 1-800-633-4227

The short version for Mississippi

In Mississippi you send the external review request form to the Mississippi Insurance Department, which passes it to your insurer for an eligibility check and then to an independent review organization. The review costs you nothing and the decision is binding on the insurer. Official online guidance is thin, so the request form and the Department's phone line (601-359-3569) are the best guides; free outside help is mostly aimed at Medicaid and the Children's Health Insurance Program.

At a glance: independent review for plans Mississippi 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: Mississippi Insurance Department (MID) · 800-562-2957 (statewide toll-free, consumers only) or 601-359-3569
Independent review: A state process (Health care external review)
Deadline to request it: 4 months after you receive the insurer's denial (adverse determination or final adverse determination)
Cost: none listed; the regulation makes the insurer pay the cost of the independent review organization
Decision time: 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

Mississippi Insurance Department (MID)
Health insurance companies and policies sold in Mississippi (individual plans and fully insured employer plans).

Phone: 800-562-2957 (statewide toll-free, consumers only) or 601-359-3569. File a complaint online

Independent (external) review

Process: A state process. Run by Mississippi Insurance Department (Life and Health Actuarial Division), which assigns an independent review organization.
Where you file: regulator
How: Complete the External Review Request Form and mail it to: Office of the Insurance Commissioner, Mississippi Insurance Department, Attn: Life and Health Actuarial Division, P.O. Box 79, Jackson, MS 39205. Include a copy of your insurance card, the insurer's final denial letter, and your certificate of coverage or benefit booklet. Call (601) 359-3569 if you need help or the case is urgent.
Which denials qualify: Denials where the insurer judged the service or treatment did not meet its requirements for medical necessity, appropriateness, health care setting, level of care or effectiveness, and denials of treatment as experimental or investigational.
Appeal to the plan first?: Yes. You are treated as having exhausted the internal process if you filed a grievance and got no written decision within 30 days, or if the insurer waives the requirement. An expedited review needs your treating provider to certify that waiting would seriously jeopardize your life, health or ability to regain maximum function.

Official page Request form

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

Free help in Mississippi

Health Help Mississippi (Mississippi Health Advocacy Program)
Free nonprofit enrollment and advocacy help for Mississippians applying or reapplying for Medicaid and the Children's Health Insurance Program (CHIP).

Phone: 1-877-314-3843

Medicare and Medicaid in Mississippi

Medicare counseling: Mississippi State Health Insurance Assistance Program (SHIP), Mississippi Department of Human Services, Division of Aging and Adult Services · 844-822-4622 . Free help with Medicare appeals.
Medicaid agency: Mississippi Division of Medicaid (the managed care program is called MississippiCAN)
Fair hearing deadline: If you are in a MississippiCAN health plan: 120 calendar days from the date on the plan's final Notice of Appeal Resolution. For other decisions, follow the deadline printed on your notice. Your notice states the deadline that applies to you.
Good to know: In managed care you must finish the health plan's appeal first (one plan gives 60 calendar days from its denial notice to appeal). To keep benefits during the hearing, ask within 10 calendar days of the plan's final decision. Send a written request to: Mississippi Division of Medicaid, Attn: Office of Appeals, P.O. Box 2222, Jackson, Mississippi 39225; phone 601-359-6050 or 1-800-884-3222.

How Medicaid appeals work

State laws that can help

External review. You can file for external review with the Insurance Commissioner within four months of a denial, the insurer pays for the review, and the decision is binding on the insurer.

Mississippi Health Carrier External Review Regulation, Title 19, Part 3, Chapter 15 (Rules 15.07, 15.10 and 15.15)
Prior authorization. Insurers must decide a prior authorization request within 7 calendar days of getting the needed information, and within 48 hours for urgent care.

Mississippi Prior Authorization Reform Act, Senate Bill 2140 (2024)
Step therapy. Your prescriber must have a clear way to request an override of step therapy, which the insurer must grant promptly if the required drug has been ineffective, is likely to be ineffective, or is likely to cause harm; a step therapy trial generally cannot be required for more than 30 days once the prescriber finds it ineffective.

Mississippi Code section 83-9-36

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 (7)

The Medicaid fair hearing page. the Division of Medicaid website (medicaid.ms.gov) could not be loaded (certificate error), so no official appeals page was confirmed
The Medicaid fair hearing deadline. the 120-day rule and the Office of Appeals contact details come from a MississippiCAN health plan's member page, not from the Division of Medicaid; the deadline for fee-for-service and eligibility decisions was not confirmed
The cost of independent review. the Department's consumer page does not mention a fee; the regulation says the insurer pays the review organization
Free consumer help programs. the federal directory lists Mississippi as having a Consumer Assistance Program; this program's site describes Medicaid and CHIP help and does not mention private insurance denials
The Medicare counseling program's web page. the state page loaded lists the 844-822-4622 line as the 'MS Access to Care Helpline'; the number matches the federal SHIP directory
State laws that help. step therapy statute text read on a third-party legal site, not the official code
How to tell whether the state regulates your plan. no official Mississippi tip found

Sources last checked 11 November 2026. Found a mistake? Report it.