New to helping someone in Ohio?
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.
Ohio 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 Ohio Department of Insurance (ODI) for medical disputes—or review by the superintendent for pure contractual issues.
For steps that work in every state, read these general guides first, then return here for Ohio rules:
What is different in Ohio?
- HealthCare.gov: Ohio uses the federal Marketplace at HealthCare.gov. Major 2026 carriers include Anthem Blue Cross Blue Shield, Medical Mutual, Molina, CareSource, and UnitedHealthcare (availability varies by county).
- Prior authorization: R.C. § 3923.041 and § 1751.72 — 48 hours urgent / 10 calendar days standard; 12-month PA for chronic drugs; gold carding (HB 122) for high-approval providers.
- Internal appeals: Chapter 3922 — typically 180 days to file; 30-day pre-service / 60-day post-service decisions; 72-hour urgent appeals.
- External review: Request within 180 days of final denial; IRO decision within 45 days standard / 72 hours expedited (ODI); binding on plan for eligible medical disputes.
- Medicaid: MCO appeal first (60 days), then state fair hearing (90 days from MCO resolution)—separate from commercial IRO review.
Who is in charge of your plan?
- ODI: External review, consumer help — insurance.ohio.gov. Consumer hotline: 800-686-1526 · 614-644-2673 · External Review: 614-644-0188
- U.S. Department of Labor: Many self-funded employer plans.
- Ohio Medicaid / ODJFS Bureau of State Hearings: Medicaid appeals and fair hearings — Request a state hearing · 866-635-3748
- CMS / OSHIIP: Medicare and Medicare Advantage (ODI Medicare help: 800-686-1578).
After appeals are exhausted, see Regulator complaints.