By state / North Carolina
North Carolina
- Regulator
- North Carolina Department of Insurance (Smart NC)
- External review
- State-run. Request it through the regulator after the plan's final internal denial; the federal floor is 4 months (45 CFR 147.136).
- Published reversal rate
- 0.5426% of reviews reversed the plan (153 of 282, 2024) · source
- Notes
- Smart NC received 282 external review requests through November 2024 and overturned 153 (~53%). Per Smart NC and NBC News reporting (2025). Annual report: https://www.ncleg.gov/Files/Library/agency/doi13339.pdf
Before external review
File the plan's internal appeal first (at least 180 days for ACA-compliant plans; the letter states the date). Ask for the claim file and the criteria the plan applied; both are free on request. Self-funded employer plans use the federal external review and the U.S. Department of Labor, not the state.
More on North Carolina: state appeal rights · External Review Index entry · insurer denial rates (HealthCare.gov states).
Verified 2026-09-15. The regulator's site and your denial notice control.