Pennsylvania: Start Here
Beginner guide for Pennsylvania—Pennie, PID external review, Act 146 PA & § 2164 internal appeals.
Read guideState playbook
Pennsylvania
State insurers, legislation, and appeal resources for patients and advocates in Pennsylvania.
4 guides
Pennsylvania Prior Authorization Law
Act 146 § 991.2155—72-hour/15-day PA, Rx timelines, specialist reviewers, no emergency PA.
Read guidePennsylvania Health Insurance Appeals and Grievances
Act 146 § 2164—180-day filing, 30/60-day decisions, deemed exhaustion, path to PID IRO.
Read guidePennsylvania External Review (PID / IRO)
Binding, no fee—4-month filing with PID, 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.
- Highmark
- Independence Blue Cross
- UPMC Health Plan
- Geisinger Health Plan
- Capital Blue Cross
- Ambetter Health of Pennsylvania
- Oscar Health (Pennsylvania)
- Pennie (Pennsylvania Marketplace)
- Pennsylvania Medicaid
External appeals
After internal appeal, for eligible Pennsylvania fully insured plans only.
- PID — independent external review
- Medicaid — DHS fair hearing