In Montana, external review of a denied health-plan claim runs under the Commissioner of Securities and Insurance (the Office of the State Auditor), governed by the state's Independent Review statute (Title 33, Chapter 32, MCA). You file the request with your health insurer within 120 days of the denial; the insurer must then randomly assign an independent review organization from the Commissioner's approved list, and that decision binds the plan. There's no fee to the consumer, and the Commissioner's advocates assist for free.
How Montana's external review works
Montana's external review is set in statute (Title 33, Chapter 32, MCA) and overseen by the Commissioner of Securities and Insurance, part of the Office of the State Auditor. The mechanics are distinctive: you file the request with the insurer, not the state — but the insurer doesn't get to hand-pick the reviewer. Within one business day it must randomly assign an independent review organization from the Commissioner's approved list, which keeps the choice neutral.
- The request is filed with the health insurer, which must forward it for review.
- The insurer randomly assigns the IRO from the Commissioner's approved list — no cherry-picking the reviewer.
- The IRO's decision binds the plan.
- The Commissioner's consumer advocates help with denied-claim appeals at no cost (800-332-6148).
Plan type still governs
The 120-day deadline
You have 120 days after you receive the notice of the plan's adverse (or final adverse) determination to file a request for external review with your insurer. Miss it and the case is time-barred, so start the request promptly once the denial arrives.
How to file
- 1
Exhaust the internal appeal
Complete the plan's internal appeal first (urgent cases can move in parallel).
- 2
File the request with your insurer
Montana's statute routes the external-review request through the health insurer, not the state agency.
- 3
The insurer assigns an IRO at random
Within one business day, the insurer randomly assigns an independent review organization from the Commissioner's approved list.
- 4
Get help if you need it
The Commissioner's Consumer Advocates (800-332-6148) assist with appeals for free.
How fast — and who pays
- Standard: the IRO decides within 45 days of receiving the request; you can submit additional information within 10 business days of the assignment notice.
- Expedited (urgent): within 72 hours.
- There is no filing fee for the consumer.
- The decision is binding on the plan.
For Montana providers and billers
Montana has recently constrained prior authorization in ways worth citing in an appeal. The prior-authorization statute (§ 33-32-221) bars PA for defined drug categories — for example, generics after six months of continuous use, formulary insulin, and certain FDA-approved substance-use-disorder treatments at labeled dosing — and requires adverse drug-PA determinations to be made by a same-specialty physician, with a list of covered alternatives. A utilization-review approval is also valid for at least three months (§ 33-32-107).
Frequently asked
How long do I have to file an external review in Montana?
Who picks the reviewer?
How fast is the decision?
Is there a fee?
Does Montana's external review cover an ERISA plan?
Primary sources: Montana CSI — Insurance complaints & consumer help; Mont. Code Ann. § 33-32-410 (right to external review); Mont. Code Ann. § 33-32-411 (expedited external review); Mont. Code Ann. § 33-32-221 (prior authorization requirements); 45 CFR 147.136 (internal claims, appeals & external review); HealthCare.gov — external review process. General information, not legal or medical advice — confirm against the governing rule for the plan type.
When the appeal has to be written, and cited
Upload the denied EOB and Merits returns a complete, citation-verified appeal letter — the clinical argument, the payer's own coverage criteria, and your federal appeal rights — in about a minute.