State guide
Nevada
Pick the kind of plan you have to see who to call first. Nevada 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
Nevada 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 Nevada Division 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 Nevada.
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Medicare
Nevada Medicare Assistance Program (MAP), Nevada's State Health Insurance Assistance Program gives free counseling. Or call 1-800-MEDICARE.
The short version for Nevada
Nevada is unusual because external review requests go to the Office for Consumer Health Assistance, a free state advocate office, rather than to the insurance regulator. That same office helps people with appeals, bills and insurance rights. State law requires the outside reviewer to decide a standard case within 15 days of getting the information it needs, which is faster than most states.
At a glance: independent review for plans Nevada regulates
- Main regulator
- Nevada Division of Insurance · Las Vegas office (702) 486-4009; Carson City office (775) 687-0700
- Independent review
- A state process (External review)
- Deadline to request it
- 4 months after you receive notice of the denial (adverse determination)
- Cost
- No fee to you is stated; state law makes the health carrier pay the cost of the external review
- Decision time
- 15 days after the independent review organization receives the information it needs to decide; fast track: The office decides within 72 hours whether your case qualifies as urgent; the reviewer must then finish within 48 hours of being assigned and tell you by phone within 24 hours after that
Who regulates health plans
- Nevada Division of Insurance
Insurance companies and health insurance policies sold in Nevada. It takes complaints such as improper denial or delay in settling a claim.
Phone: Las Vegas office (702) 486-4009; Carson City office (775) 687-0700. File a complaint online
Independent (external) review
- Process
- A state process. Run by Nevada Office for Consumer Health Assistance (OCHA), which checks eligibility and assigns an independent review organization.
- Where you file
- regulator
- How
- Send the External Review Request Form to the Office for Consumer Health Assistance, a state office (it is not the Division of Insurance). For an urgent (expedited) review, call the office first at (888) 333-1597 or 725-281-3122, and have your treating provider complete the certification form.
- Which denials qualify
- Denials of a covered benefit because the insurer says it does 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 must first complete your plan's internal appeal. Exceptions in state law: the insurer agrees to skip the internal appeal, the insurer misses its deadline to decide, or the case is urgent or life-threatening and qualifies for expedited external review.
Free help in Nevada
- Nevada Office for Consumer Health Assistance (OCHA)
Free state office that explains your health insurance rights, helps file appeals and quality-of-care complaints, helps with medical bills, and runs Nevada's external review process.
Phone: (888) 333-1597 or (725) 281-3122
- Nevada Legal Services
Free legal services program that Nevada Medicaid lists on its fair hearing form as possible help for people who cannot afford a lawyer for a Medicaid appeal.
Phone: Las Vegas (702) 386-0404 or (866) 432-0404; Reno (775) 284-3491; Carson City and other counties (775) 883-0404 or (800) 323-8666; Elko (775) 753-5880
Medicare and Medicaid in Nevada
- Medicare counseling
- Nevada Medicare Assistance Program (MAP), Nevada's State Health Insurance Assistance Program · 1-800-307-4444 . Free help with Medicare appeals.
- Medicaid agency
- Nevada Medicaid (Nevada Health Authority)
- Fair hearing deadline
- Medicaid must receive your request within 90 calendar days from the Notice Date. Your notice states the deadline that applies to you.
- Good to know
- To keep your services the same during the hearing process you must ask for the hearing no more than 10 calendar days after the Date of Action on the notice and ask that services continue; you may have to pay back the cost if you lose. There is no charge for a fair hearing. Send the request to: Nevada Medicaid Hearings Unit, 9850 Double R Blvd, Ste 200, Reno, NV 89521; fax 775-684-3610; email medicaidhearings@nvha.nv.gov.
State laws that can help
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Step therapy. Insurers that use step therapy must offer a clear process to request an exemption and to appeal a refusal, must answer within 2 business days (24 hours in urgent cases) or the request is treated as granted, and must grant it when the doctor documents listed reasons such as the required drug being likely to harm you, not work, or having already failed.
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Step therapy. A health policy may not require step therapy before covering a drug prescribed by a psychiatrist (or certain other listed prescribers) for a psychiatric condition when the prescriber expects the required alternative drugs to be ineffective.
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Prior authorization. Insurers must act on prior authorization requests within two business days and may not require prior authorization for certain preventive services, outpatient substance use disorder services and glucose test strips.
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Surprise billing. Nevada law prohibits balance billing in certain emergency situations, so you owe only what you would have paid an in-network provider; employer plans governed by federal law can opt in to the Nevada rules.
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External review. Gives covered people 4 months to ask for external review, requires a decision within 15 days in standard cases, makes the insurer pay for the review, and makes a decision in your favor binding on the insurer.
Sources and what we could not confirm
- External Review | Nevada Office for Consumer Health Assistance
- Office for Consumer Health Assistance (OCHA)
- Nevada Revised Statutes Chapter 695G (Managed Care)
- Nevada Consumer Assistance | Centers for Medicare & Medicaid Services
- Affordable Care Act: Working with States to Protect Consumers (state external review list) | Centers for Medicare & Medicaid Services
- Consumers | Nevada Division of Insurance
- File a Complaint | Nevada Division of Insurance
- Balance Billing FAQs | Nevada Division of Insurance
- Fair Hearings | Nevada Medicaid
- Recipient Fair Hearing Request Form NMO-6300E (Nevada Medicaid)
- Nevada | State Health Insurance Assistance Programs
- Bills Signed by the Governor, 83rd (2025) Session | Nevada Legislature
- Despite bipartisan push for insurance approval reform in NV Legislature, only 1 bill succeeded | The Nevada Independent
- NRS 689A.04048 (step therapy for psychiatric drugs) | Justia
Not confirmed (9)
- The state regulators. only the two office numbers were found on the Division's consumer page; no toll-free consumer line was confirmed
- How to tell whether the state regulates your plan. no Nevada page explaining how to tell from your card whether the state regulates your plan was found
- The independent review request form. the form link on the official page is a relative path; the adsd.nv.gov domain was assumed
- The cost of independent review. the statute says the health carrier pays for the review; no official page states in so many words that it is free to the consumer
- How to file for independent review. the current office page lists 650 White Drive, Las Vegas and phone 725-281-3122, while an older copy of the request form lists 3320 W. Sahara Avenue and (702) 486-3587 and the federal directory lists 7150 Pollock Drive; confirm the mailing address by phone before sending
- Free consumer help programs. Nevada Legal Services phone numbers come from the Nevada Medicaid fair hearing form; its website was not loaded
- Notes on Medicaid appeals. whether managed care members must finish a health plan appeal before a state fair hearing was not confirmed on a state page
- State laws that help. the text of NRS 689A.04043 was read in a third-party reproduction, not on the Legislature's site; similar sections for group and managed care plans were not checked
- State laws that help. the description of Assembly Bill 463 comes from news coverage (The Nevada Independent); the bill text was not read