New to helping someone in Nevada?
You do not need a law degree to help someone fight a health insurance denial. Start by gathering three basic documents:
- Insurance card — shows which company administers the plan. Use the name and phone number on the card when you call or file paperwork.
- Denial letter or explanation of benefits (EOB) — the notice that says a service was denied, not paid, or needs approval first. Look for appeal instructions and a deadline.
- Summary of Benefits and Coverage (SBC) — helps you tell whether the fight is about medical necessity or whether the benefit exists at all.
Your first tasks: identify what type of plan this is (Marketplace, job-based, Medicaid, Medicare) and write down the appeal deadline from the letter.
Nevada law gives you an internal appeal with the carrier first in most cases, then a right to external review through an independent review organization (IRO) assigned by the Office for Consumer Health Assistance (OCHA).
For steps that work in every state, read these general guides first, then return here for Nevada rules:
What is different in Nevada?
- Nevada Health Link: Nevada runs its own state-based Marketplace at NevadaHealthLink.com. Major carriers include Health Plan of Nevada, Anthem, SilverSummit (Ambetter), Hometown Health, Molina, SelectHealth, CareSource, and others—check your county.
- Prior authorization (AB 463, effective 2026): Amended NRS 687B.225 requires response within 2 business days (max 7 calendar days); missed deadlines → deemed approved.
- Internal appeals: Often 180 days to file (ACA plans); managed-care complaints resolved within 30 days under NRS 695G.200–695G.210.
- External review: Request from OCHA within four months (NRS 695G.251); IRO decision often within 15 days (§ 695G.253) or 72 hours expedited (§ 695G.271).
- Nevada Medicaid: MCO appeal first (often 60 days), then DHCFP fair hearing (often 90 days from MCO final notice)—separate from commercial external review.
Who is in charge of your plan?
- OCHA (Office for Consumer Health Assistance): External review intake, consumer help — adsd.nv.gov — OCHA. 702-486-3587 or 888-333-1597.
- Nevada Division of Insurance: Regulates carriers, certifies IROs — doi.nv.gov.
- DHCFP — Medicaid Hearings Unit: Fair hearings — 9850 Double R Blvd., Suite 200, Reno, NV 89521; 775-684-3604.
- CMS: Medicare and Medicare Advantage.
After appeals are exhausted, see Regulator complaints.