New to helping someone in New Hampshire?
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.
New Hampshire 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 New Hampshire Insurance Department.
For steps that work in every state, read these general guides first, then return here for New Hampshire rules:
What is different in New Hampshire?
- HealthCare.gov Marketplace: New Hampshire uses the federal Marketplace at HealthCare.gov. Major carriers include Matthew Thornton (Anthem), Harvard Pilgrim, Ambetter from NH Healthy Families, and WellSense. Check current year availability in your county.
- Prior authorization (SB 561, effective 2025): RSA 420-J:6 sets 3 business days (electronic non-urgent) to 72 hours (non-electronic urgent); missed deadlines → deemed approved; Rx PA within 2 business days (RSA 420-J:7-b).
- Internal appeals: File within 180 days (RSA 420-J:5); decision often within 30 days (72-hour expedited when urgent).
- External review: Request from the Insurance Department within 180 days (RSA 420-J:5-a); IRO decision often within 15 days after information is complete (up to 60 days per NHID);72-hour expedited when urgent.
- New Hampshire Medicaid: MCO appeal first (often 60 days), then DHHS fair hearing (120 days from MCO resolution)—separate from commercial external review.
Who is in charge of your plan?
- NH Insurance Department: External review, consumer help, PA oversight — insurance.nh.gov. Consumer assistance: 800-852-3416 or 603-271-2261.
- U.S. Department of Labor: Many self-funded employer plans.
- DHHS — Medicaid fair hearings: After MCO appeal — 800-852-3345, ext. 4292.
- CMS: Medicare and Medicare Advantage.
After appeals are exhausted, see Regulator complaints.