New to helping someone in Utah?
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 and whether Utah Insurance Department (UID) regulates the plan.
- 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 (HealthCare.gov, job-based, Medicaid, Medicare) and write down the appeal deadline from the letter.
For many Utah-regulated plans, you have an internal appeal with the carrier first, then a right to independent review through an IRO—often administered by the Utah Insurance Department under Admin. Code R590-261.
For steps that work in every state, read these general guides first, then return here for Utah rules:
What is different in Utah?
- HealthCare.gov: Utah uses the federal Marketplace at HealthCare.gov. Major 2026 carriers include SelectHealth, Regence BlueCross BlueShield of Utah, Molina, BridgeSpan, University of Utah Health Plans, and Imperial Health Plan (availability varies by county).
- Prior authorization: § 31A-22-650 — no PA for emergency care; 30-day advance notice before new PA requirements; step therapy exceptions ( § 31A-22-645); SB 319 reforms effective January 1, 2027.
- Internal appeals: Federal standards for many plans — typically 180 days to file; 30/60-day decisions; 72-hour urgent.
- Independent review: File with UID or carrier within 180 days of final denial; IRO decision within 45 days standard / 72 hours expedited; binding on plan when UID administers review.
- Medicaid: MCO grievance/appeal first, then state fair hearing — 120 days from MCO final notice (service appeals) or 90 days for many eligibility notices—not commercial IRO review.
Who is in charge of your plan?
- Utah Insurance Department (UID): Independent review, fully insured commercial plans — insurance.utah.gov. Health appeals: 801-957-9280 · toll-free 800-439-3805 · healthappeals.uid@utah.gov
- U.S. Department of Labor / HHS: Many self-funded ERISA plans and some federal external review paths.
- DHHS Office of Administrative Hearings: Medicaid fair hearings — Medicaid hearings
- CMS: Medicare and Medicare Advantage.
After appeals are exhausted, see Regulator complaints.