New to helping someone in Colorado?
Start with three things from the patient or family:
- Insurance card — shows the carrier and plan name
- Denial letter or explanation of benefits (EOB) — lists appeal rights and deadlines
- Summary of Benefits and Coverage (SBC) — if available
Your first job is to learn what kind of plan this is (Marketplace, job-based, Medicaid, Medicare) and what deadline the letter gives you. Colorado plans often use terms like adverse determination, first level review, and independent external review.
For steps that work in every state, use these general guides first, then return here for Colorado rules:
What is different in Colorado?
- Connect for Health Colorado: Colorado runs its own state-based Marketplace at connectforhealthco.com (six carriers for 2026: Anthem, Cigna, Denver Health, Kaiser, Rocky Mountain Health Plans, SelectHealth). Enrollment is not on HealthCare.gov (healthinsurance.org — Colorado Marketplace).
- Division of Insurance (DOI): Regulates most individual and fully insured commercial health coverage in Colorado, including external review (C.R.S. § 10-16-113.5).
- Prior authorization law: Non-urgent medical PA often within 5 business days; urgent within 2 business days / 72 hours, with deemed approved if the carrier is late (C.R.S. § 10-16-112.5).
- State external review: After internal appeals, many plans can get a binding independent external review assigned by DOI—4 months to request, 45 days standard / 72 hours expedited.
- Health First Colorado (Medicaid): Managed care plan appeals plus state fair hearings through the Office of Administrative Courts—not the commercial insurance statutes.
Who is in charge of your plan?
- Colorado Division of Insurance: Fully insured health plans, consumer complaints, independent external review — doi.colorado.gov. Consumer line: 303-894-7490 or 1-800-883-2800.
- U.S. Department of Labor: Many self-funded employer plans.
- Health First Colorado / HCPF: Medicaid eligibility and managed care — healthfirstcolorado.com — appeals; fair hearings: Office of Administrative Courts 303-866-2000.
- CMS: Medicare and Medicare Advantage.
For filing a complaint after appeals, see Regulator complaints.