New to helping someone in North Dakota?
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.
North Dakota law gives you an internal appeal with the insurer first in most cases, then a right to external review through an independent review organization (IRO) assigned by the North Dakota Insurance Department.
For steps that work in every state, read these general guides first, then return here for North Dakota rules:
What is different in North Dakota?
- HealthCare.gov: North Dakota uses the federal Marketplace at HealthCare.gov. Major 2026 carriers include Blue Cross Blue Shield of North Dakota, Sanford Health Plan, and Medica (availability varies by county).
- Prior authorization (SB 2280 / Ch. 26.1-36.12): Effective January 1, 2026 — 7 calendar days non-urgent / 72 hours urgent; missed deadlines → deemed authorized; no PA for emergencies or MAT for opioid use disorder; PA valid 6–12 months (N.D.C.C. ch. 26.1-36.12).
- Internal appeals: Follow plan and Ch. 26.1-26.4 procedures; Marketplace plans often allow 180 days to file with 30-day pre-service / 60-day post-service decisions (federal standards).
- External review: File within four months of final denial (NCDOI); IRO decision within 45 days standard / 72 hours expedited; binding on plan.
- Medicaid: MCO appeal first (often 60 days), then state fair hearing (often 90–120 days from MCO resolution under federal rules)—separate from commercial IRO review.
Who is in charge of your plan?
- NCDOI: External review, consumer help — insurance.nd.gov. Consumer hotline: 800-247-0560 · 701-328-2440 · insurance@nd.gov
- U.S. Department of Labor: Many self-funded employer plans.
- ND Health and Human Services: Medicaid appeals and fair hearings — hhs.nd.gov — file an appeal
- CMS: Medicare and Medicare Advantage (ND SHIP: 888-575-6611).
After appeals are exhausted, see Regulator complaints.