What is an internal appeal?
An internal appeal asks the insurance company to reconsider its own adverse decision about coverage or payment. The plan (or its utilization review organization) reviews the case again under Kansas's utilization review rules.
This is different from independent medical review (IMR), where the Kansas Department of Insurance contracts with an external reviewer who does not work for your insurer.
General walkthrough: Appeals roadmap. Kansas specifics below.
Kansas appeal timelines
K.S.A. 40-22a09a sets how Kansas-regulated health plans must run internal appeals when utilization review applies (read statute):
Written notice and your rights
- The plan must give you written notice of any adverse decision and explain internal appeal procedures, contact information, and your right to external review (IMR)
- If the plan has two internal levels, you may waive the second level in writing and go directly to IMR—that written waiver counts as exhausting internal appeals
Second internal level (if you use it)
If you request the second internal appeal, the plan must decide within:
- 72 hours for an emergency medical condition
- 15 business days for a pre-service claim (including many PA disputes)
- 30 days for a post-service claim (care already provided)
You may appear in person (or by phone) before the second-level panel, bring records, ask questions, and be represented by someone you choose. Request to appear at least 5 working days before the meeting (or 24 hours for emergencies).
First internal level
The first level follows procedures in your plan documents and denial letter. Many Marketplace and employer plans also follow federal notice rules—your letter should state how many days you have to appeal.
When you can skip waiting
Under K.S.A. 40-22a14, you may request IMR if you have exhausted internal appeals—or if you have not received a final decision within 60 days of seeking internal review (unless you agreed to a delay).
How to file
- Read the adverse decision letter for the appeal address, fax, portal, or phone number and the deadline.
- Submit before the deadlineusing the plan's form or a clear letter stating you are appealing.
- Ask whether you are on level one or two if the plan has multiple internal levels.
- Consider waiving the second level in writing if you are ready for IMR and the statute allows it.
- Keep proof of submission and note the date you filed (important for the 60-day exhaustion rule).
KID Consumer Assistance: 800-432-2484 — insurance.kansas.gov — health consumers.
Evidence that helps
- Letter from the treating doctor explaining medical necessity and why alternatives fail
- Recent clinical notes, test results, and treatment history
- Peer-reviewed guidelines when relevant
- Prior approvals for the same service on the same plan
KanCare appeals
KanCare members appeal an MCO adverse decision with Healthy Blue, Sunflower, or UnitedHealthcare first (follow deadlines on the MCO notice, often 60 days). If you disagree with the MCO's appeal outcome, request a state fair hearing through the Office of Administrative Hearings.
KanCare — appeals & fair hearings · OAH hearing forms
For urgent health situations, complete the MCO's expedited appeal before requesting an expedited fair hearing.
After internal appeal
If you receive a final adverse decision on medical necessity or experimental/investigational treatment, you may qualify for independent medical review through KID. File within 120 days of the adverse decision.
Kansas independent medical review (KID)
Self-funded ERISA plans may use federal external review instead — see Self-funded ERISA plans.