State guide
Nebraska
Pick the kind of plan you have to see who to call first. Nebraska 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
Nebraska 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 Nebraska Department of Insurance. 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 Nebraska.
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Medicare
Nebraska SHIP (State Health Insurance Assistance Program), run by the Nebraska Department of Insurance gives free counseling. Or call 1-800-MEDICARE.
The short version for Nebraska
Nebraska runs its own external review through the Department of Insurance, with an online portal that lets you track your case. A 2025 law that took effect in 2026 tightened prior authorization rules and bars insurers from denying care based only on an artificial intelligence tool. Nebraska has no separate consumer assistance program for health insurance, so the Department of Insurance is the main place to get help.
At a glance: independent review for plans Nebraska regulates
- Main regulator
- Nebraska Department of Insurance · (402) 471-2201; Insurance Complaint Hotline 877-564-7323 (in-state only)
- Independent review
- A state process (External review under the Health Carrier External Review Act)
- Deadline to request it
- 4 months from the date you receive the denial notice
- Cost
- No fee is mentioned on the Department's page or on the request form
- Decision time
- 45 days after the external review request is received; fast track: 72 hours
Who regulates health plans
The Department says self-funded (self-insured) benefit plans are not under its jurisdiction and its external review form says most self-funded plans are not eligible. If you are not certain whether your employer plan is self-funded, ask your employer's benefits coordinator.
- Nebraska Department of Insurance
Health insurance policies and health maintenance organization (HMO) plans issued in Nebraska. It does not oversee self-funded (self-insured) employer plans, Medicare, Medicaid, or plans issued in another state.
Phone: (402) 471-2201; Insurance Complaint Hotline 877-564-7323 (in-state only). File a complaint online
Independent (external) review
- Process
- A state process. Run by Nebraska Department of Insurance, which assigns the case to an independent review organization.
- Where you file
- regulator
- How
- File through the Department of Insurance External Review Secure Portal (https://ecmp.nebraska.gov/doi-er), or complete the paper External Review Request Form and send it to the Department by mail or fax. If you need an expedited (fast) review, call the Department first at (402) 471-2201 for the quickest way to submit.
- Which denials qualify
- Denials saying a covered service does not meet the insurer's requirements for medical necessity, appropriateness, health care setting, level of care or effectiveness, and denials saying a treatment is experimental or investigational. Denials for other reasons (for example an out-of-network provider, a contract exclusion or an unmet deductible) are not eligible.
- Appeal to the plan first?
- Yes. The Department says a case is eligible only after the insurer's internal appeals are exhausted. The request form adds that you may ask for external review without finishing internal appeals "under certain circumstances" (for example when the insurer waives the requirement) and tells you to contact the Department.
Medicare and Medicaid in Nebraska
- Medicare counseling
- Nebraska SHIP (State Health Insurance Assistance Program), run by the Nebraska Department of Insurance · 1-800-234-7119 . Free help with Medicare appeals.
- Medicaid agency
- Nebraska Department of Health and Human Services, Division of Medicaid and Long-Term Care (Heritage Health managed care program)
- Fair hearing deadline
- 120 days from the date on your health plan's notice of resolution of your appeal. For decisions made by the state itself (for example eligibility), 90 days from the mailing date of the notice. Your notice states the deadline that applies to you.
- Good to know
- You must appeal to your Heritage Health plan first, within 60 days of the date on the denial notice (called a notice of adverse benefit determination). To keep services going during the appeal you must ask within 10 calendar days of that notice. A State Fair Hearing request must be in writing and sent to: Department of Health and Human Services, Medicaid and Long-Term Care Appeal Coordinator, PO Box 94967, Lincoln, NE 68509-4967.
State laws that can help
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Step therapy. Insurers must offer a clear way to ask for a step-therapy override, must approve it in listed situations (for example the required drug is expected to harm you or not work, or you are stable on your current drug), must answer within 5 calendar days (72 hours if urgent) or the request is treated as granted, and a denial upheld on internal appeal can go to external review.
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Prior authorization. For state-regulated plans, prior authorization rules must be public, denials must be made by a physician with a peer-to-peer conversation available on request, standard forms are required, and a new plan must honor a prior approval from your previous plan for at least the first 60 days of coverage.
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AI in utilization review. An artificial intelligence-based algorithm may not be the sole basis for a decision to deny, delay or modify care on medical necessity grounds, and reviewers must disclose if they use such algorithms.
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Surprise billing. For emergency care, facilities and providers may not bill you more than the in-network deductible, copayment or coinsurance under your plan, even if they are out of network.
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External review. State law gives people in Nebraska-regulated plans the right to have a neutral outside reviewer decide medical necessity and experimental-treatment denials.
Sources and what we could not confirm
- Appealing Denied Health Claim | Nebraska Department of Insurance
- Health | Nebraska Department of Insurance
- External Review Request Form (Nebraska Department of Insurance)
- Nebraska Health Insurance Consumer Help | Centers for Medicare & Medicaid Services
- Affordable Care Act: Working with States to Protect Consumers (state external review list) | Centers for Medicare & Medicaid Services
- Seniors / Medicare | Nebraska Department of Insurance
- Nebraska | State Health Insurance Assistance Programs
- Appeals - Nebraska Heritage Health
- Medicaid Provider Bulletin 23-21: Eligibility and Benefit Appeal Timeframe
- Nebraska Revised Statute 44-7,115 (step-therapy override exception)
- Legislative Bill 77 (2025), slip law
- New prior-authorization form to be utilized starting Jan. 2026 | Nebraska Department of Insurance
- No Surprises Act - New Protection from Surprise Balance Bills | Nebraska Department of Insurance
Not confirmed (5)
- The cost of independent review. neither the Department's page nor the request form mentions a fee; the statute itself was not read to confirm there is none
- Whether you must appeal to the plan first. the official form says exceptions exist "under certain circumstances" but does not list them
- Free consumer help programs. the federal directory lists no Consumer Assistance Program for Nebraska and no statewide program that clearly helps with insurance denials was confirmed
- The Medicaid fair hearing page. this is the state's Heritage Health enrollment site; a Department of Health and Human Services page dedicated to fair hearings was not found
- Not confirmed. stateLaws (prior-authorization) — the physician-review and peer-to-peer points come from the Nebraska Medical Association's summary of LB 77, not from a full read of the bill text