New York: Start Here
Beginner guide for New York—NY State of Health, DFS external review, Insurance Law § 4903 PA & § 4904 appeals.
Read guideState playbook
New York
State insurers, legislation, and appeal resources for patients and advocates in New York.
4 guides
New York Prior Authorization Law
Insurance Law § 4903—3-day/72-hour PA, deemed approved, step therapy overrides, HIV/PrEP PA ban.
Read guideNew York Health Insurance Appeals and Grievances
Appeal within 45+ days—30-day UR decision, 2-day expedited, deemed reversed, path to DFS external review.
Read guideNew York External Review (DFS)
Binding on plan—four-month filing, 30-day standard / 72-hour expedited, IPRO and other appeal agents.
Read guidePrior auth & internal appeals
Match the plan on the member ID card. Use the denial letter for where to file appeals.
- EmblemHealth
- Fidelis Care
- Healthfirst
- MVP Health Care
- MetroPlus Health Plan
- Oscar Health
- UnitedHealthcare of New York
- NY State of Health (Marketplace)
- Medicaid managed care
External appeals
After internal appeal, for eligible New York fully insured plans only.