District of Columbia: Start Here
Beginner guide for D.C.—DC Health Link, PA reform, Ombudsman external review, and what to open next.
Read guideState playbook
District of Columbia
State insurers, legislation, and appeal resources for patients and advocates in District of Columbia.
4 guides
D.C. Prior Authorization Law
3/5-day and 24-hour PA deadlines, deemed approval, SUD protections, and electronic PA requirements.
Read guideD.C. Health Insurance Appeals and Grievances
180-day filing, 30/60-day responses, 24-hour urgent appeals, path to Ombudsman external review.
Read guideD.C. External Review
Ombudsman/IRO binding review—4-month filing, 45-day standard, 72-hour expedited, fully insured D.C. plans.
Read guidePrior auth & internal appeals
Match the plan on the member ID card. Use the denial letter for where to file appeals.
- CareFirst BlueCross BlueShield (D.C.)
- Kaiser Permanente Mid-Atlantic
- UnitedHealthcare
- D.C. Medicaid / Alliance
External appeals
After internal appeal, for eligible District of Columbia fully insured plans only.
- Office of Health Care Ombudsman — External Review
- DISB — Consumer help