Your state regulator and external review
For insured plans, the state insurance department runs (or contracts) the external review that follows a final internal denial, and takes complaints. Self-funded employer plans, Medicare and TRICARE are federal and do not go here.
| State | Regulator | System | Reversal rate |
|---|---|---|---|
| Alabama | HHS-Administered Federal External Review (MAXIMUS Federal Services) | HHS-administered | not published |
| Alaska | Alaska Division of Insurance | state-run | not published |
| Arizona | Arizona Department of Insurance and Financial Institutions (DIFI) | state-run | 0.21% |
| Arkansas | Arkansas Insurance Department | state-run | not published |
| California | California Department of Managed Health Care (DMHC) | state-run | 0.727% |
| Colorado | Colorado Division of Insurance (DORA) | state-run | 0.44% |
| Connecticut | Connecticut Insurance Department / Office of the Healthcare Advocate | state-run | 0.8% |
| Delaware | Delaware Department of Insurance | state-run | not published |
| District of Columbia | DC Department of Insurance Securities and Banking (DISB) | state-run | not published |
| Florida | HHS-Administered Federal External Review (MAXIMUS Federal Services) | HHS-administered | not published |
| Georgia | HHS-Administered Federal External Review (MAXIMUS Federal Services) | HHS-administered | not published |
| Hawaii | Hawaii Insurance Division (DCCA) | state-run | not published |
| Idaho | Idaho Department of Insurance | state-run | not published |
| Illinois | Illinois Department of Insurance (IDOI) | state-run | not published |
| Indiana | Indiana Department of Insurance | state-run | not published |
| Iowa | Iowa Insurance Division | state-run | not published |
| Kansas | Kansas Insurance Department | state-run | 0.54% |
| Kentucky | Kentucky Department of Insurance | state-run | not published |
| Louisiana | Louisiana Department of Insurance | state-run | not published |
| Maine | Maine Bureau of Insurance (Consumer Health Care Division) | state-run | not published |
| Maryland | Maryland Insurance Administration (MIA) | state-run | 0.668% |
| Massachusetts | Massachusetts Office of Patient Protection (OPP) at Health Policy Commission | state-run | 0.4% |
| Michigan | Michigan Department of Insurance and Financial Services (DIFS) | state-run | not published |
| Minnesota | Minnesota Department of Commerce | state-run | 0.43% |
| Mississippi | HHS-Administered Federal External Review (MAXIMUS Federal Services) | HHS-administered | not published |
| Missouri | Missouri Department of Commerce and Insurance | state-run | not published |
| Montana | Montana Commissioner of Securities and Insurance | state-run | not published |
| Nebraska | Nebraska Department of Insurance | state-run | not published |
| Nevada | Nevada Division of Insurance | state-run | not published |
| New Hampshire | New Hampshire Insurance Department | state-run | not published |
| New Jersey | New Jersey Department of Banking and Insurance (DOBI) IHCAP | state-run | not published |
| New Mexico | New Mexico Office of Superintendent of Insurance (OSI) | state-run | not published |
| New York | New York Department of Financial Services (DFS) | state-run | not published |
| North Carolina | North Carolina Department of Insurance (Smart NC) | state-run | 0.5426% |
| North Dakota | North Dakota Insurance Department | state-run | not published |
| Ohio | Ohio Department of Insurance | state-run | not published |
| Oklahoma | Oklahoma Insurance Department | state-run | not published |
| Oregon | Oregon Division of Financial Regulation (DFR) | state-run | 0.3885% |
| Pennsylvania | Pennsylvania Insurance Department (PID) | state-run | 0.484% |
| Rhode Island | Rhode Island Office of the Health Insurance Commissioner (OHIC) | state-run | not published |
| South Carolina | South Carolina Department of Insurance | state-run | 0.43% |
| South Dakota | South Dakota Division of Insurance | state-run | not published |
| Tennessee | Tennessee Department of Commerce and Insurance (TDCI) | state-run | not published |
| Texas | Texas Department of Insurance (TDI) | state-run | not published |
| Utah | Utah Insurance Department | state-run | not published |
| Vermont | Vermont Department of Financial Regulation (DFR) | state-run | not published |
| Virginia | Virginia Bureau of Insurance (State Corporation Commission) | state-run | not published |
| Washington | Washington Office of the Insurance Commissioner (OIC) | state-run | 0.25% |
| West Virginia | West Virginia Offices of the Insurance Commissioner | state-run | 0.17% |
| Wisconsin | HHS-Administered Federal External Review (MAXIMUS Federal Services) / Wisconsin OCI | HHS-administered | not published |
| Wyoming | Wyoming Department of Insurance | state-run | not published |
| Puerto Rico | Puerto Rico Office of the Insurance Commissioner | state-run | not published |