Montana: Start Here
Beginner guide for Montana—HealthCare.gov Marketplace, CSI/IRO external review, ch. 32 PA & grievance deadlines.
Read guideState playbook
Montana
State insurers, legislation, and appeal resources for patients and advocates in Montana.
4 guides
Montana Prior Authorization Law
MCA §§ 33-32-211–221—7 business day/48-hour PA, prescription PA limits, clinical rationale in denials.
Read guideMontana Health Insurance Appeals and Grievances
Grievance within 180 days—30/60-day issuer decision, 72-hour expedited, exhaustion path to § 33-32-410.
Read guideMontana External Review (CSI / IRO)
Binding on issuer—120-day filing with carrier, 45-day standard, 72-hour expedited, MCA Title 33, ch. 32, pt. 4.
Read guidePrior auth & internal appeals
Match the plan on the member ID card. Use the denial letter for where to file appeals.
- Blue Cross Blue Shield of Montana
- Montana Health CO-OP (Mountain Health)
- PacificSource (exiting MT)
- HealthCare.gov (Montana Marketplace)
- Montana Medicaid (DPHHS)
External appeals
After internal appeal, for eligible Montana fully insured plans only.
- CSI — external review / IRO
- Medicaid — fair hearing