By state / Pennsylvania

Pennsylvania

Regulator

Pennsylvania Insurance Department (PID)

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

0.484% of reviews reversed the plan (655 of 1,353, 2025) · source

Notes

PA Independent External Review Program (launched 2024-01) referred 1353 eligible cases to IROs since inception through 2025; 655 overturned (~48%). First-year (2024) rate was 50.1%. Program is one of newest state-run replacements for HHS-administered process.

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 Pennsylvania: 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.