State guide
Wyoming
Pick the kind of plan you have to see who to call first. Wyoming 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
Wyoming 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 Wyoming 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 Wyoming.
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Medicare
Wyoming State Health Insurance Information Program (WSHIIP), run by Wyoming Senior Citizens, Inc gives free counseling. Or call 1-800-MEDICARE.
The short version for Wyoming
Wyoming runs a state external review only for denials based on lack of medical necessity: you file a written request with your insurer within 120 days of the final denial, using the state's form, and a state-registered independent review organization decides. The review is binding and free apart from a $15 filing fee that can be waived for hardship. Since 2024 Wyoming also has a prior authorization law with decision deadlines, step therapy protections and provider gold cards. Wyoming has no Consumer Assistance Program, so the Department of Insurance's Consumer Affairs staff are the main free state contact.
At a glance: independent review for plans Wyoming regulates
- Main regulator
- Wyoming Department of Insurance · 307-777-7402 (Consumer Affairs); toll-free 800-438-5768
- Independent review
- A state process (Independent Medical Claim Review (external review by an Independent Review Organization))
- Deadline to request it
- 120 days after the date of the final denial letter
- Cost
- $15 filing fee (check or money order to the Wyoming State Treasurer), waived for financial hardship; the review itself is free and the insurer pays for it
- Decision time
- 45 days after the review organization receives the request; fast track: 72 hours (the request must include your treating physician's certification)
Who regulates health plans
- Wyoming Department of Insurance
Health insurance sold in Wyoming by insurance companies (individual and fully insured employer plans). It cannot force an insurer to pay your claim, and it does not regulate employer self-funded plans, Medicare or Medicaid.
Phone: 307-777-7402 (Consumer Affairs); toll-free 800-438-5768. File a complaint online
Independent (external) review
- Process
- A state process. Run by Your insurer assigns your request to an Independent Review Organization registered with the Wyoming Department of Insurance, which rotates assignments and is notified of each request.
- Where you file
- insurer
- How
- After you finish your insurer's internal appeals, send a written request to your insurer within 120 days of the final denial letter, on Wyoming's External Review Request Form (the insurer must give you the form with the denial notice). Include a copy of the denial letter and your insurance card, and pay the $15 fee or complete the fee waiver section. The insurer sends the request to the review organization and the Department of Insurance.
- Which denials qualify
- Denials of coverage or payment because the insurer says the service is not medically necessary, after you have had at least one internal review. The service must appear to be covered by your policy apart from the medical necessity finding.
- Appeal to the plan first?
- Yes, you must exhaust all levels of your insurer's internal appeal or grievance process. A Wyoming consumer guide says you can ask for expedited external review at the same time as an expedited internal review.
Free help in Wyoming
- Wyoming Department of Insurance, Consumer Affairs Section
Answers questions about your policy and investigates complaints about improper claim denials and delays by state-regulated insurers; the federal directory lists no separate Consumer Assistance Program for Wyoming.
Phone: 307-777-7402
- Legal Aid of Wyoming
Free legal help with health care issues for people who qualify by income (seniors qualify under a separate grant); call the hotline Monday to Friday, 9 a.m. to 4 p.m., to ask whether they take insurance denial or Medicaid appeal cases.
Phone: 1-877-432-9955
Medicare and Medicaid in Wyoming
- Medicare counseling
- Wyoming State Health Insurance Information Program (WSHIIP), run by Wyoming Senior Citizens, Inc. · 1-800-856-4398 . Free help with Medicare appeals.
- Medicaid agency
- Wyoming Department of Health, Wyoming Medicaid (Division of Healthcare Financing)
- Fair hearing deadline
- Wyoming's Medicaid hearing rule (Chapter 4) says 20 business days after the notice of adverse action was mailed; the Department's own FAQ and member handbooks say 30 days. Treat the earlier date as your deadline. Your notice states the deadline that applies to you.
- Good to know
- You can request a hearing by email, by phone, by certified mail or in person, and the Department must say within 10 business days whether it accepted the request. If you ask for the hearing before the effective date on your notice, services generally cannot be stopped or cut until the final decision (unless the only issue is state or federal law); you may have to repay the cost if you lose. Medicaid customer service: 1-855-294-2127.
State laws that can help
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Prior authorization. Insurers must tell you and your provider their prior authorization decision within 5 calendar days (72 hours if urgent, including mental health care), must have a physician or licensed provider make any denial, must honor a prior insurer's authorization for at least 90 days after you change plans, and must keep most authorizations valid for a year.
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Step therapy. You cannot be made to repeat a step therapy requirement if you already used the required drug, or a similar one in the same class, and stopped because it did not work, caused an adverse event, or was contraindicated.
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Gold card. Starting January 1, 2026, a provider with at least 5 prior authorization requests in 12 months and a 90 percent approval rate is exempt from prior authorization for that service with that insurer (prescription drugs are excluded).
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Denial notice. When an insurer denies a claim as not medically necessary after review, it must give you a written explanation of why, plus the external review procedure, deadlines and the state's request form; you then have 120 days to request external review.
Sources and what we could not confirm
- Wyoming DOI: Independent Medical Claim Review Process
- Wyoming DOI: Consumers
- Wyoming DOI: Consumer Information (complaints)
- Wyoming DOI: Prior Authorization
- Wyoming Legislature: 2024 HB0014 Prior authorization regulations
- Wyoming Statutes 26-40-201 (Justia)
- Mountain Health CO-OP: Wyoming External Review Request Form (state form text)
- CMS: State External Appeals Review Processes
- CMS: Wyoming Health Insurance Consumer Help
- Wyoming Department of Health: Medicaid Rules Chapter 4 (administrative hearings)
- Wyoming Medicaid: Frequently Asked Questions
- Wyoming Medicaid: Member Handbook for Adults
- Wyoming Senior Citizens: WSHIIP
- SHIP National Technical Assistance Center: Wyoming
- Legal Aid of Wyoming: Health Care
Not confirmed (9)
- The state regulators. the Department's 'File a Complaint' link is an external portal whose address was not visible in the page text; the consumer information page that links to it is given instead.
- The independent review request form. the state form is linked on the Department's page but its address was not captured; the form text was read via an insurer's copy.
- Not confirmed. externalReview.decisionsDatabaseUrl and statistics — no public decisions database or overturn rate was found.
- Which denials qualify for independent review. medical necessity only, from W.S. 26-40-201 and the Department page; the Wyoming consumer guide's mention of expedited eligibility for emergency stays was not found on an official page.
- Not confirmed. externalReview.mustExhaustInternalFirst (concurrent expedited review) — from a third-party guide (Coverage Rights), not an official page.
- The Medicaid fair hearing deadline. official sources disagree: Chapter 4 rule says 20 business days after mailing, the Department's FAQ and handbooks say 30 days.
- Not confirmed. stateLaws (step-therapy, prior-authorization) — dates and details taken from the enrolled act text and Department FAQ; the current statute sections were not re-read, and the Department's gold card guidance was not checked beyond its FAQ.
- Not confirmed. consumerAssistance (Legal Aid of Wyoming) — its health care page does not say it handles insurance denials specifically, only 'issues with Health Care'.
- Not confirmed. No state surprise billing law was researched for Wyoming.