Ohio: Start Here
Beginner guide for Ohio—HealthCare.gov, ODI external review, R.C. § 3923.041 PA & Chapter 3922 appeals.
Read guideState playbook
Ohio
State insurers, legislation, and appeal resources for patients and advocates in Ohio.
4 guides
Ohio Prior Authorization Law
R.C. § 3923.041 & § 1751.72—48-hour/10-day PA, 12-month chronic drug validity, HB 122 gold carding.
Read guideOhio Health Insurance Appeals and Grievances
Chapter 3922—180-day filing, 30/60-day decisions, deemed exhaustion, path to ODI IRO.
Read guideOhio External Review (ODI / IRO)
Binding on plan—180-day filing with issuer, 45-day IRO decision, 72-hour expedited.
Read guidePrior auth & internal appeals
Match the plan on the member ID card. Use the denial letter for where to file appeals.
- Anthem Blue Cross and Blue Shield (Ohio)
- Medical Mutual of Ohio
- Molina Healthcare of Ohio
- CareSource Ohio
- UnitedHealthcare of Ohio
- Oscar Health (Ohio)
- HealthCare.gov (Ohio Marketplace)
- Ohio Medicaid managed care
External appeals
After internal appeal, for eligible Ohio fully insured plans only.