What an external review is, and how long it takes
An external review is a reading of your denial by a reviewer who does not work for the plan, and the plan has to honour the answer. It opens once the plan has given its final no. Who runs it depends on who pays your claims, and how long you have depends on where you live.
By the Covered Weight editorial team · Updated Aug 6, 2026. Research and sourcing by Evan Reid.
What the step actually is
An internal appeal asks the plan to look again at its own decision. An external review takes the same file to somebody outside the plan. The reviewer is a clinician, the review organisation is independent of the plan by rule rather than by promise, and the organisation is not chosen by the plan in any jurisdiction this site has published.
The answer binds. That is the part readers most often do not know, and it is the reason the step is worth the paperwork: the reviewer is not making a recommendation the plan may consider. This is also why the step is narrow. The reviewer is deciding whether the treatment meets the plan's own written rules, not whether the rules are fair.
The distinction that decides whether to bother
A denial for medical necessity is a question a reviewer can answer. A denial because the plan document excludes the whole category is not: the plan applied its rule correctly, and there is nothing medical left to review. Read the denial notice for which of the two it says, because the words look similar and the consequences do not.
Who runs it depends on who pays your claims
There is no single external review process in the United States. A jurisdiction runs its own program for the plans it regulates, and a plan it does not regulate falls to the federal process instead. So two people denied the same drug on the same day, living on the same street, can have their reviews decided by two different bodies under two different rulebooks.
The line runs through who funds the plan rather than through the name on the card. The forum for each of the eight plan types gives the route with the federal rule that puts it there, and the page on employer plans that pay their own claims explains how to tell which side of that line you are on before you file anything.
When the door opens
Filing out of order is the most common way a reader loses a review that was available to them. Each jurisdiction below states its own rule, read from its own governing sections.
California
The appeal with the plan has to finish first
You have to take the plan's grievance process first, but the plan cannot run the clock forever: section 1374.30 subdivision (j)(3) says you shall not be required to participate for more than 30 days, and section 1368 says the same thing from the department's side. After that you may go to the department whether or not the plan has answered.
New York
The appeal with the plan has to finish first
The external appeal opens once the plan has issued a final adverse determination on its own utilization review appeal, so the internal step comes first. New York does not state a deemed-exhaustion rule in the sections read for this record, so if your plan misses its own deadline, ask the department rather than assuming the external route has opened.
Ohio
The appeal with the plan has to finish first, and the statute caps that appeal at 1 level
Ohio caps the internal appeal at ONE level for individual coverage, including coverage bought through a nonemployer group, so a plan cannot make you climb two ladders before the outside review opens. Note where the external request goes: to the health plan issuer, not to the state.
Texas
The appeal with the plan has to finish first
Normally the utilization review agent's own appeal comes first. Texas then carves out the case where waiting is most dangerous: for an enrollee with a life-threatening condition the statute gives an immediate appeal to an independent review organization and expressly does NOT require complying with the internal review procedures first. If that is your situation, read that section before you spend time on the internal appeal.
How long each stage runs, by jurisdiction
The first column is your window to ask. The second is the reviewer's window to answer. The third is what the same review costs when the case cannot wait. Every figure was read from the jurisdiction's own statute and carries the section it came from, and no figure is converted between units: where a statute says hours, the table says hours, because a published rule in hours and a published rule in days are not the same rule.
| Jurisdiction | You have | The reviewer has | If it is urgent | Fee |
|---|---|---|---|---|
| California | 6 monthsFrom any of the qualifying periods or events under Health and Safety Code section 1374.30, subdivision (j)Cal. Health & Safety Code § 1374.30(k) | 30 daysFrom receipt of the application for review and supporting documentation | 3 days | No charge |
| New York | 4 monthsFrom the day the insured receives notice of the final adverse determination from the planN.Y. Ins. Law § 4914(b)(1) | 30 daysFrom receipt of the request | 72 hours | $25 |
| Ohio | 180 daysFrom the date of the final adverse benefit determinationOhio Rev. Code § 3922.02(B) | 30 daysFrom the health plan issuer's receipt of the request for a standard review | 72 hours | No charge |
| Texas | Not publishedFrom the date of the notice denying the internal appealTex. Ins. Code § 4202.012 | Not publishedFrom the referral of the determination to the independent review organization | Not published | Not published |
This reads the external review clock for California, New York, Ohio and Texas. These windows come from state law, so they reach the plans the state regulates. If your employer pays claims out of its own funds, the federal process applies instead and its clock is not on this table.
Two jurisdictions showing the same number do not necessarily have the same deadline. The starting event is the part to check against your own notice: a window that runs from the plan's final letter and a window that runs from the date of service can be the same length and expire weeks apart.
A denied medication runs on a different and much shorter clock
When a plan refuses to cover a drug that is not on its list, or refuses one it does cover because a rule was not met, the route is usually a formulary exception request rather than the general appeal above. It is decided in hours. A reader counting the weeks in the table above can lose the shorter window entirely without ever knowing it was open.
California
- A standard request
- 72 hours
- When the circumstances are exigent
- 24 hours
45 C.F.R. § 156.122(c)(1)(ii)
New York
- A standard request
- 72 hours
- When the circumstances are exigent
- 24 hours
45 C.F.R. § 156.122(c)(1)(ii)
Ohio
- A standard request
- 72 hours
- When the circumstances are exigent
- 24 hours
45 C.F.R. § 156.122(c)(1)(ii)
Texas
- A standard request
- 72 hours
- When the circumstances are exigent
- 24 hours
45 C.F.R. § 156.122(c)(1)(ii)
Where a jurisdiction sets its own rule the citation above is a state one; where it does not, the deadline comes from the federal rule that applies anyway. Your own state page carries the full note for each figure, and the documentation checklist covers what the prescriber has to put in the request for either route.
Who picks the reviewer, and what it costs you
The most-asked question after the deadline is whether the plan gets to choose who reviews its own decision. In every jurisdiction published here the answer is no.
California
California Department of Managed Health Care, Help Center
The department contracts the review organizations and the statute requires them to be independent of any health care service plan doing business in California. You do not choose the reviewer and neither does your plan.
The statute is explicit that an enrollee pays no application or processing fees of any kind, and the Insurance Code says the same for a policy holder. Cost is a common reason people do not appeal, so it is worth knowing there is none.
Health and Safety Code - HSC, ARTICLE 5.55. Appeals Seeking Independent Medical Reviews [1374.30 - 1374.36], Section 1374.30, subdivision (a)
California State Legislature · Source document · Read Aug 6, 2026
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1374.30. (a) Commencing January 1, 2001, there is hereby established in the department the Independent Medical Review System.
Read from the section page text at leginfo on 2026-08-06. leginfo prints the section number immediately before subdivision (a), which is why the identity quote carries it. This is the section identity and it also carries the fact that the review system sits in the department. New York
New York State Department of Financial Services, External Appeal Unit
The superintendent assigns the external appeal agent at random, by regulation. You do not choose the reviewer and neither does your plan, and the superintendent may set a maximum fee an agent charges or drop an agent whose fee is unreasonable.
This is where New York differs from a state that charges nothing: a health plan may charge $25 for each external appeal, capped at $75 in a plan year. The plan is otherwise responsible for the cost of the appeal itself. If the fee is what is stopping you, ask the plan and the department about it rather than dropping the appeal.
New York State External Appeal, Fees
New York State Department of Financial Services · Source document · Read Aug 6, 2026
Read the line this comes from
Health plans may charge a $25.00 fee per appeal (but not more than $75.00 in a single plan year.)
Read from the program page DFS itself runs, on 2026-08-06. Cited because the fee appears NOWHERE in Insurance Law 4914 — the section was searched for "twenty-five" and for "fee", and its only fee provisions govern what the external appeal AGENT may charge and who pays the agent. The administering agency publishing its own program fee is the authority for it. The same page states the four-month filing window and gives (800) 400-8882 for help with an application. Ohio
Ohio Department of Insurance, Superintendent of Insurance
The superintendent assigns the independent review organization from a list the superintendent maintains. You do not choose the reviewer and neither does your plan.
The health plan issuer pays for the external review, including one the superintendent orders. Cost is a common reason people do not appeal, so it is worth knowing Ohio puts none of it on you.
Ohio Revised Code / Title 39 Insurance / Chapter 3922, Section 3922.05 | Opportunities for external review by independent review organization, division (F)(1)
Ohio General Assembly · Source document · Read Aug 6, 2026
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shall assign an independent review organization from the list of organizations maintained by the superintendent
From division (F)(1). The clause opens "If an external review of an adverse benefit determination is granted, the superintendent, according to any rules, policies, or procedures adopted by the superintendent" and was trimmed from the front for the 200-character limit. The list itself is maintained under section 3922.13 of the Revised Code. You do not choose the reviewer and neither does your plan. Texas
Texas Department of Insurance, Independent Review Organization referral by the commissioner
The commissioner refers adverse determinations to independent review organizations by RANDOM assignment, by rule. Neither you nor your plan picks the reviewer, and the randomness is the statutory protection: it is what stops a plan steering its cases to a friendly reviewer.
Texas publishes no fee figure for this request, so the cost is a question for the forum above rather than a number this page can print.
INSURANCE CODE TITLE 14. UTILIZATION REVIEW AND INDEPENDENT REVIEW CHAPTER 4202. INDEPENDENT REVIEW ORGANIZATIONS, Sec. 4202.012. REFERRAL
Texas Legislature · Source document · Read Aug 6, 2026
Read the line this comes from
The commissioner by rule shall require referral by random assignment of adverse determinations under Subchapter I, Chapter 4201 , to independent review organizations.
The section in full. This is the fact that decides the boundary on this page: Texas HAS its own independent review system for the plans it regulates, so a Texan is not automatically sent to the federal process. The url is a Wayback `id_` capture rather than the live page, and for a different reason than a blocked client: statutes.capitol.texas.gov serves a JavaScript shell containing no statute text, so every section url returns the same 250KB of fonts and CSS. The 2023 capture contains the real chapter. Legitimate here because this is a statute, which carries its own enactment history in the text; it would not be legitimate for a fee or a phone number. Archived copy, kept because a drug list is replaced rather than versioned.
What this page cannot tell you
It cannot tell you your own deadline. The notice you received sets the clock for your case and it is the authority, not this table. A missed appeal deadline is not itself something you can appeal, and no correction published here later would give the right back.
It also cannot tell you whether a review will go your way. Nobody can, and any site that offers you a probability is selling something. What the published record supports is the shape of the step, the window it runs in, and the document that decides your case.
The full appeal route, by jurisdiction
Common questions
What is an external review?
It is a second look at a denial by a reviewer who does not work for the plan and is not paid by the outcome. The plan has already given its final answer; the reviewer reads the same file and reaches an independent conclusion, and the plan does not get to overrule it.
Do I have to finish the appeal with the plan first?
Almost always yes. The review is a step that opens once the plan has issued a final denial, and filing before that point is a common way to lose a right that was there. An urgent case is the usual exception, and some jurisdictions treat a plan that blows its own deadline as having finished.
Can a reviewer overturn a written exclusion?
Generally no, and this is the distinction that decides whether the step is worth taking. The review asks whether the treatment meets the plan rules. When the plan document excludes the category outright, the rule was applied correctly and there is no medical question left to put to a reviewer.
Does a denied medication run on the same clock as everything else?
No, and this is the single most expensive thing to get wrong on this site. A drug denial usually runs through a formulary exception request, which is decided in hours rather than weeks. Counting the longer window can cost the shorter one entirely.
What does it cost?
In most places nothing. A few jurisdictions allow the plan to charge a small filing fee with an annual cap, and the plan pays for the review itself either way. The table on this page prints the published figure for each jurisdiction, with the statute it came from.
Documents this page reads
Health and Safety Code - HSC, ARTICLE 5.55. Appeals Seeking Independent Medical Reviews [1374.30 - 1374.36], Section 1374.30, subdivision (a)
California State Legislature · Source document · Read Aug 6, 2026
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1374.30. (a) Commencing January 1, 2001, there is hereby established in the department the Independent Medical Review System.
Read from the section page text at leginfo on 2026-08-06. leginfo prints the section number immediately before subdivision (a), which is why the identity quote carries it. This is the section identity and it also carries the fact that the review system sits in the department. Health and Safety Code - HSC, ARTICLE 5.55. Appeals Seeking Independent Medical Reviews [1374.30 - 1374.36], Section 1374.30, subdivision (k)
California State Legislature · Source document · Read Aug 6, 2026
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within six months of any of the qualifying periods or events under subdivision (j). The director may extend the application deadline beyond six months if the circumstances of a case warrant
The tail of the first sentence of subdivision (k) plus the sentence after it, so the excerpt carries both the six-month window and the discretionary extension. The leading clause naming the enrollee's right to apply was dropped to stay inside the 200-character limit. Health and Safety Code - HSC, ARTICLE 5.55. Appeals Seeking Independent Medical Reviews [1374.30 - 1374.36], Section 1374.33, subdivision (a)
California State Legislature · Source document · Read Aug 6, 2026
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1374.33. (a) Upon receipt of information and documents related to a case, the medical professional reviewer or reviewers selected to conduct the review by the independent medical review organization
Read from the section page text at leginfo on 2026-08-06. leginfo prints the section number immediately before subdivision (a), which is why the identity quote carries it. Cited for the section identity; the deadline itself is in subdivision (c). Health and Safety Code - HSC, ARTICLE 5.55. Appeals Seeking Independent Medical Reviews [1374.30 - 1374.36], Section 1374.33, subdivision (c)
California State Legislature · Source document · Read Aug 6, 2026
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The organization shall complete its review and make its determination in writing, and in layperson’s terms to the maximum extent practicable, within 30 days of the receipt of the application
The first sentence of subdivision (c), read from the section page text; "for review and supporting documentation, or within less time as prescribed by the director" was trimmed to stay inside the 200-character limit. Health and Safety Code - HSC, ARTICLE 5.55. Appeals Seeking Independent Medical Reviews [1374.30 - 1374.36], Section 1374.30, subdivision (j)(3)
California State Legislature · Source document · Read Aug 6, 2026
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The enrollee shall not be required to participate in the plan's grievance process for more than 30 days.
From subdivision (j)(3), read from the section page text. The same subdivision caps expedited cases at three days. Health and Safety Code - HSC, ARTICLE 5. Standards [1367 - 1374.198], Section 1368, subdivisions (a) and (b)(1)(A)
California State Legislature · Source document · Read Aug 6, 2026
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1368. (a) Every plan shall do all of the following: (1) Establish and maintain a grievance system approved by the department under which enrollees may submit their grievances to the plan.
Read from the section page text at leginfo on 2026-08-06. leginfo prints the section number immediately before subdivision (a), which is why the identity quote carries it. Cited for the section identity. Subdivision (b)(1)(A) lets a subscriber or enrollee submit the grievance to the department after participating in the process for at least 30 days, the same cap stated from the department's side. Health and Safety Code - HSC, ARTICLE 5. Standards [1367 - 1374.198], Section 1368.01, subdivision (a)
California State Legislature · Source document · Read Aug 6, 2026
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1368.01. (a) The grievance system shall require the plan to resolve grievances within 30 days, except as provided in subdivision (c).
Read from the section page text at leginfo on 2026-08-06. leginfo prints the section number immediately before subdivision (a), which is why the identity quote carries it. The "except as provided in subdivision (c)" is the drug carve-out, recorded separately. Health and Safety Code - HSC, ARTICLE 5. Standards [1367 - 1374.198], Section 1368.01, subdivision (c)
California State Legislature · Source document · Read Aug 6, 2026
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that provides coverage for outpatient prescription drugs shall comply with subdivision (c) of Section 156.122 of Title 45 of the Code of Federal Regulations
From subdivision (c), read from the section page text; the subject "A health care service plan contract in the individual, small group, or large group markets" was trimmed for the 200-character limit. This is what the two "except as provided in subdivision (c)" clauses point at. Code of Federal Regulations, Title 45, Part 156 (Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges), Section 156.122 Prescription drug benefits, paragraph (c)(1)(ii)
U.S. Government Publishing Office, Electronic Code of Federal Regulations · Federal regulation · Read Aug 6, 2026
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of its coverage determination no later than 72 hours following receipt of the request
The closing clause of paragraph (c)(1)(ii), read from the eCFR section page. Its subject is a health plan making its determination on a standard exception request and notifying the enrollee and the prescriber. Code of Federal Regulations, Title 45, Part 156 (Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges), Section 156.122 Prescription drug benefits, paragraph (c)(2)(iii)
U.S. Government Publishing Office, Electronic Code of Federal Regulations · Federal regulation · Read Aug 6, 2026
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of its coverage determination no later than 24 hours following receipt of the request
The closing clause of paragraph (c)(2)(iii), read from the eCFR section page. Its subject is a health plan deciding an expedited exception request based on exigent circumstances. Health and Safety Code - HSC, ARTICLE 5.55. Appeals Seeking Independent Medical Reviews [1374.30 - 1374.36], Section 1374.30, subdivision (l)
California State Legislature · Source document · Read Aug 6, 2026
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The enrollee shall pay no application or processing fees of any kind.
Subdivision (l) in full, read from the section page text. Insurance Code - INS, ARTICLE 3.5. Appeals Seeking Independent Medical Review [10169 - 10169.5], Section 10169, subdivision (l)
California State Legislature · Source document · Read Aug 6, 2026
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The insured shall pay no application or processing fees of any kind.
Subdivision (l) in full, read from the section page text. Insurance (ISC) CHAPTER 28, ARTICLE 49, TITLE 2, Section 4914, subdivision (b)(1)
New York State Senate · Source document · Read Aug 6, 2026
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The insured shall have four months to initiate an external appeal after the insured receives notice from the health care plan
From subdivision (b)(1). The sentence continues "or such plan's utilization review agent if applicable, of a final adverse determination or denial" and was trimmed for the 200-character limit. The url is a Wayback `id_` capture rather than the live page: www.nysenate.gov answers 403 to a self-identifying bot user-agent, so the weekly quote verifier could never re-read the live url and the corpus is FATAL on a quote no machine has read. Legitimate here because this is a statute, which carries its own revision date; it would not be legitimate for a fee or a phone number. Archived copy, kept because a drug list is replaced rather than versioned.
New York State External Appeal, Fees
New York State Department of Financial Services · Source document · Read Aug 6, 2026
Read the line this comes from
Health plans may charge a $25.00 fee per appeal (but not more than $75.00 in a single plan year.)
Read from the program page DFS itself runs, on 2026-08-06. Cited because the fee appears NOWHERE in Insurance Law 4914 — the section was searched for "twenty-five" and for "fee", and its only fee provisions govern what the external appeal AGENT may charge and who pays the agent. The administering agency publishing its own program fee is the authority for it. The same page states the four-month filing window and gives (800) 400-8882 for help with an application. Insurance (ISC) CHAPTER 28, ARTICLE 49, TITLE 2, Section 4914, subdivision (b)(2)
New York State Senate · Source document · Read Aug 6, 2026
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The external appeal agent shall make a determination with regard to the appeal within thirty days of the receipt of the request
From subdivision (b)(2), read from the section page text. The url is a Wayback `id_` capture rather than the live page: www.nysenate.gov answers 403 to a self-identifying bot user-agent, so the weekly quote verifier could never re-read the live url and the corpus is FATAL on a quote no machine has read. Legitimate here because this is a statute, which carries its own revision date; it would not be legitimate for a fee or a phone number. Archived copy, kept because a drug list is replaced rather than versioned.
Insurance (ISC) CHAPTER 28, ARTICLE 49, TITLE 2, Section 4914, subdivision (b)(3)
New York State Senate · Source document · Read Aug 6, 2026
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the external appeal shall be completed within no more than seventy-two hours of the request
From subdivision (b)(3), read from the section page text. Seventy-two hours is the outer limit for an expedited external appeal. The url is a Wayback `id_` capture rather than the live page: www.nysenate.gov answers 403 to a self-identifying bot user-agent, so the weekly quote verifier could never re-read the live url and the corpus is FATAL on a quote no machine has read. Legitimate here because this is a statute, which carries its own revision date; it would not be legitimate for a fee or a phone number. Archived copy, kept because a drug list is replaced rather than versioned.
Insurance (ISC) CHAPTER 28, ARTICLE 49, TITLE 1, Section 4904, subdivision (c)
New York State Senate · Source document · Read Aug 6, 2026
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A utilization review agent must establish a period of no less than forty-five days after receipt of notification by the insured of the initial utilization review determination
From subdivision (c). The same subdivision requires a determination on the appeal within thirty days of receipt of the information needed to conduct it. The url is a Wayback `id_` capture rather than the live page: www.nysenate.gov answers 403 to a self-identifying bot user-agent, so the weekly quote verifier could never re-read the live url and the corpus is FATAL on a quote no machine has read. Legitimate here because this is a statute, which carries its own revision date; it would not be legitimate for a fee or a phone number. Archived copy, kept because a drug list is replaced rather than versioned.
Insurance (ISC) CHAPTER 28, ARTICLE 49, TITLE 2, Section 4914, subdivision (d)(1)
New York State Senate · Source document · Read Aug 6, 2026
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Except as provided in paragraphs two and three of this subsection, payment for an external appeal shall be the responsibility of the health care plan.
Subdivision (d)(1) in full. Paragraphs (2) and (3) shift cost to a PROVIDER who appealed a concurrent determination and do not reach the insured; the section contains no consumer fee, checked including for the word "twenty-five". The url is a Wayback `id_` capture rather than the live page: www.nysenate.gov answers 403 to a self-identifying bot user-agent, so the weekly quote verifier could never re-read the live url and the corpus is FATAL on a quote no machine has read. Legitimate here because this is a statute, which carries its own revision date; it would not be legitimate for a fee or a phone number. Archived copy, kept because a drug list is replaced rather than versioned.
Ohio Revised Code / Title 39 Insurance / Chapter 3922, Section 3922.02 | Request for review of adverse benefit determination, division (B)
Ohio General Assembly · Source document · Read Aug 6, 2026
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within one hundred eighty days of the date of the final adverse benefit determination
From division (B), read from the section page at codes.ohio.gov on 2026-08-06. The sentence opens "All requests for external review shall be made in writing, including by electronic means, by the covered person to the health plan issuer" and was trimmed to stay inside the 200-character limit. Note the request goes to the ISSUER, not to the state. Ohio Revised Code / Title 39 Insurance / Chapter 3922, Section 3922.05 | Opportunities for external review by independent review organization, division (H)(1)
Ohio General Assembly · Source document · Read Aug 6, 2026
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shall provide written notice of its decision to either uphold or reverse the determination within thirty days of receipt by the health plan issuer of a request for a standard review
From division (H)(1). The subject is "An independent review organization assigned to review an adverse benefit determination", and the clause continues with a seventy-two-hour rule for an expedited request; both were trimmed for the 200-character limit. Ohio Revised Code / Title 39 Insurance / Chapter 3922, Section 3922.09 | Request for expedited external review, division (E)
Ohio General Assembly · Source document · Read Aug 6, 2026
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no more than seventy-two hours after receipt by the health plan issuer of a request for an expedited, external review, the assigned independent review organization shall uphold or reverse
From division (E). The clause opens "As expeditiously as the covered person's medical condition requires, but" — the statute sets seventy-two hours as an outer limit on a duty that is otherwise as-fast-as-needed, which is a stronger rule than the number alone suggests. Ohio Revised Code / Title 39 Insurance / Chapter 3922, Section 3922.04 | Exhaustion of issuer's internal appeal process
Ohio General Assembly · Source document · Read Aug 6, 2026
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shall not require more than one level of internal appeal before the individual may request an external review
Read from the section page. The subject the clause governs is "individual health insurance coverage, including coverage offered to individuals through nonemployer groups", trimmed from the front to stay inside the 200-character limit. The printed section heading is "Exhaustion of issuer's internal appeal process". Ohio Revised Code / Title 39 Insurance / Chapter 3922, Section 3922.18 | Payment of costs
Ohio General Assembly · Source document · Read Aug 6, 2026
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shall pay the cost of the external review, including the cost of any external review that is required at the direction of the superintendent
From the section, whose printed heading is "Payment of costs". The subject is "The health plan issuer against which a request for a standard external review or an expedited external review is filed". INSURANCE CODE TITLE 14. UTILIZATION REVIEW AND INDEPENDENT REVIEW CHAPTER 4202. INDEPENDENT REVIEW ORGANIZATIONS, Sec. 4202.012. REFERRAL
Texas Legislature · Source document · Read Aug 6, 2026
Read the line this comes from
The commissioner by rule shall require referral by random assignment of adverse determinations under Subchapter I, Chapter 4201 , to independent review organizations.
The section in full. This is the fact that decides the boundary on this page: Texas HAS its own independent review system for the plans it regulates, so a Texan is not automatically sent to the federal process. The url is a Wayback `id_` capture rather than the live page, and for a different reason than a blocked client: statutes.capitol.texas.gov serves a JavaScript shell containing no statute text, so every section url returns the same 250KB of fonts and CSS. The 2023 capture contains the real chapter. Legitimate here because this is a statute, which carries its own enactment history in the text; it would not be legitimate for a fee or a phone number. Archived copy, kept because a drug list is replaced rather than versioned.
INSURANCE CODE TITLE 14. UTILIZATION REVIEW AND INDEPENDENT REVIEW CHAPTER 4201. UTILIZATION REVIEW AGENTS, Sec. 4201.360. IMMEDIATE APPEAL TO INDEPENDENT REVIEW ORGANIZATION IN LIFE-THREATENING CIRCUMSTANCES
Texas Legislature · Source document · Read Aug 6, 2026
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entitled to an immediate appeal to an independent review organization as provided by Subchapter I; and (2) not required to comply with procedures for an internal review
From the section, which opens "Notwithstanding any other law, in a circumstance involving an enrollee's life-threatening condition, the enrollee is:". This is the exhaustion carve-out and it is the most consequential thing on the Texas page. The url is a Wayback `id_` capture rather than the live page, and for a different reason than a blocked client: statutes.capitol.texas.gov serves a JavaScript shell containing no statute text, so every section url returns the same 250KB of fonts and CSS. The 2023 capture contains the real chapter. Legitimate here because this is a statute, which carries its own enactment history in the text; it would not be legitimate for a fee or a phone number. Archived copy, kept because a drug list is replaced rather than versioned.
INSURANCE CODE TITLE 14. UTILIZATION REVIEW AND INDEPENDENT REVIEW CHAPTER 4201. UTILIZATION REVIEW AGENTS, Sec. 4201.359. NOTICE OF APPEAL, subsection (a)
Texas Legislature · Source document · Read Aug 6, 2026
Read the line this comes from
as soon as practicable, but not later than the 30th calendar day, after the date the utilization review agent receives the appeal
From subsection (a); the opening "The procedures for appealing an adverse determination must require written notice to the appealing party of the determination of the appeal" was trimmed for the 200-character limit. Note the statute says CALENDAR day explicitly, and that "as soon as practicable" sits in front of the 30 days, so the number is an outer limit on a faster duty. The url is a Wayback `id_` capture rather than the live page, and for a different reason than a blocked client: statutes.capitol.texas.gov serves a JavaScript shell containing no statute text, so every section url returns the same 250KB of fonts and CSS. The 2023 capture contains the real chapter. Legitimate here because this is a statute, which carries its own enactment history in the text; it would not be legitimate for a fee or a phone number. Archived copy, kept because a drug list is replaced rather than versioned.
INSURANCE CODE TITLE 14. UTILIZATION REVIEW AND INDEPENDENT REVIEW CHAPTER 4201. UTILIZATION REVIEW AGENTS, Sec. 4201.357. EXPEDITED APPEAL FOR DENIAL OF EMERGENCY CARE, CONTINUED HOSPITALIZATION, PRESCRIPTION DRUGS OR INTRAVENOUS INFUSIONS, subsection (a-1)
Texas Legislature · Source document · Read Aug 6, 2026
Read the line this comes from
a procedure for an expedited appeal of a denial of prescription drugs or intravenous infusions for which the patient is receiving benefits under the health insurance policy
From subsection (a-1), which adds this route on top of the written appeal and the (a) expedited route. The reviewer must not have seen the case before and must be of the same or a similar specialty. The url is a Wayback `id_` capture rather than the live page, and for a different reason than a blocked client: statutes.capitol.texas.gov serves a JavaScript shell containing no statute text, so every section url returns the same 250KB of fonts and CSS. The 2023 capture contains the real chapter. Legitimate here because this is a statute, which carries its own enactment history in the text; it would not be legitimate for a fee or a phone number. Archived copy, kept because a drug list is replaced rather than versioned.