After No
Urgent help
Menu Close

State guide

Utah

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

On this page 8

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

The short version for Utah

Utah runs its own independent review process through the Utah Insurance Department: you send one request form to the department, the insurer pays the reviewer, and you have 180 days after the final denial to ask. Utah has no state Consumer Assistance Program or health care ombudsman for private insurance, so the Insurance Department's Health and Life Division is the main source of free help. The state does not publish a searchable database of review decisions or overturn rates.

At a glance: independent review for plans Utah 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
Utah Insurance Department · 801-957-9280 (health insurance); in-state toll-free 800-439-3805
Independent review
A state process (Independent review)
Deadline to request it
180 calendar days after you receive the final denial (final adverse benefit determination)
Cost
None stated; the state rule requires the insurer to pay the independent review organization
Decision time
45 calendar days after the review organization receives the request; the department's form says the whole process is typically 55 days; fast track: 72 hours after the review organization receives the request; the department's form says typically 7 days for the whole expedited process

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

Check your health insurance identification card. The Utah Insurance Department says to look for "State Regulated" on the front or back of the card for an individual or employer fully insured plan, which the department oversees if it was bought in Utah. If the card says "Administered by", it is likely an employer self-funded plan, and you would go to the employer or the U.S. Department of Labor at 866-444-3272.

  • Utah Insurance Department

    Individual and employer fully insured health plans bought in Utah, plus Medicare supplement (Medigap) policies bought in Utah. It has no authority over employer self-funded plans (U.S. Department of Labor) or Medicare Advantage and Part D plans (Medicare).

    Phone: 801-957-9280 (health insurance); in-state toll-free 800-439-3805. File a complaint online

Independent (external) review

Process
A state process. Run by Utah Insurance Department for health benefit plans (it sends the case to an approved independent review organization). The department says some types of health insurance have a review administered by the insurer instead; ask your insurer which applies.
Where you file
regulator
How
Fill out the Independent Review Request Form and send it with a copy of your insurance card, the denial letter and supporting medical records to the Utah Insurance Department by mail (4315 S. 2700 W., Suite 2300, Taylorsville, UT 84129), fax ((385) 465-6047) or email (healthappeals@utah.gov). For urgent cases or experimental treatment denials your doctor must also complete the certification page in the form. For help call 801-957-9280.
Which denials qualify
Denials based on medical necessity, appropriateness, health care setting, level of care or effectiveness; denials calling a treatment experimental or investigational; and rescissions (retroactive cancellations) of coverage. Available regardless of the dollar amount.
Appeal to the plan first?
Yes, unless the insurer agrees to waive its internal review, the insurer did not follow its own review process (other than a minor harmless slip), or you ask for an expedited independent review at the same time as an expedited internal review.

Official page Request form

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

Free help in Utah

Medicare and Medicaid in Utah

Medicare counseling
Senior Health Insurance Information Program (SHIP) · 1-800-541-7735 . Free help with Medicare appeals.
Medicaid agency
Utah Department of Health and Human Services, Utah Medicaid
Fair hearing deadline
90 days from the date of the notice you disagree with for a Medicaid or Children's Health Insurance Program eligibility or disability decision (as stated by the state); the state page does not give a number of days for hearings after a managed care plan appeal. Your notice states the deadline that applies to you.
Good to know
If a Medicaid managed care plan (Accountable Care Organization or other managed care entity) denied the service, you must finish that plan's appeal process before asking the Office of Administrative Hearings for a hearing (phone 801-538-6576). Eligibility hearings are filed with the Department of Workforce Services, not the Office of Administrative Hearings.

Medicaid appeals page How Medicaid appeals work

State laws that can help

  • External review. Gives you 180 days to ask the Insurance Department for an independent review, makes the insurer pay for it, makes the decision binding on the insurer, and lets the reviewer rule for you if the insurer fails to send the records.

    Utah Administrative Code R590-261 (Health Benefit Plan Adverse Benefit Determinations)

  • Prior authorization. Insurers must post their prior authorization rules and approval, denial and appeal statistics online, cannot revoke an approval after the provider delivers the approved care as authorized, and cannot require prior authorization for emergency care; the version taking effect January 1, 2027 adds decision deadlines (7 calendar days, 72 hours for urgent care), approvals lasting at least 12 months for chronic conditions, review of medical necessity denials by a person using independent medical judgment, and a posted notice if the insurer uses artificial intelligence to review requests.

    Utah Code 31A-22-650

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. Utah Insurance Department: Independent Review
  2. Utah Insurance Department: Independent Review Request Form (PDF)
  3. Utah Insurance Department: Complaints
  4. Utah Insurance Department: Health Insurance
  5. Utah Insurance Department: Directory
  6. Utah Administrative Code R590-261-6, Exhaustion of Internal Review Process (Cornell Legal Information Institute copy)
  7. Utah Administrative Code R590-261-8, General Independent Review Requirements (Cornell Legal Information Institute copy)
  8. Utah Administrative Code R590-261-9, Standard Independent Review (Cornell Legal Information Institute copy)
  9. Utah Administrative Code R590-261-10, Expedited Independent Review (Cornell Legal Information Institute copy)
  10. Utah Code 31A-22-650 (version effective January 1, 2027)
  11. CMS: State External Appeals Review Processes
  12. CMS: Consumer Assistance Program (Utah listed as having no program)
  13. Utah Medicaid: Hearings
  14. SHIP National Technical Assistance Center: Utah
  15. Utah Division of Aging and Adult Services: Seniors
Not confirmed (6)
  • The state regulators. the Independent Review page prints the toll-free number once as (800) 439-3905 and once as (800) 439-3805; the directory, complaints page and site footer all print 800-439-3805, which is used here.
  • Not confirmed. externalReview.deadline, fee, standardDecisionTime, expeditedDecisionTime, mustExhaustInternalFirst — read from the Cornell Legal Information Institute copy of Utah Administrative Code R590-261, not from the state's own rules site; the department's consumer page does not state them.
  • Who runs the independent review. the department says the review is administered by either the insurer or the department depending on the type of health insurance, without listing which types; a separate rule (R590-203) describes insurer-run voluntary independent review with the same 180-day deadline.
  • The Medicaid fair hearing deadline. the state page gives 90 days only for eligibility and disability decisions; the deadline for a hearing after a managed care plan appeal was not found on an official page.
  • Not confirmed. stateLaws (prior-authorization) — only the version effective January 1, 2027 was read in full; which of its provisions are already in the version in force today was not confirmed.
  • State laws that help. no Utah step therapy, state surprise billing or mental health parity statute was confirmed on an official page, so none is listed.

Sources last checked . Found a mistake? Report it.