Ohio external review (IRO) process
After internal appeal exhaustion, Ohio offers external review by an Independent Review Organization. The IRO decision binds the plan.
When external review applies
Required by ACA §2719 for non-grandfathered commercial plans. Federal IRO process applies to self-funded ERISA plans. State IRO process applies to fully-insured plans in $Ohio.
Key steps
- Exhaust internal appeal first (one or two levels depending on plan)
- Receive final internal denial notice — it must state external review rights + how to request
- Verify the request deadline from the final notice and the current authority responsible for this plan
- Submit clinical documentation supporting your appeal to the IRO
- Record the response-date source and follow the expedited instructions if the case qualifies
- If IRO overturns, plan MUST cover the service
Ohio contact
Frequently asked questions
How do I request external review in Ohio?
Use the instructions in the current final adverse determination and confirm the governing route with Ohio's current source (https://insurance.ohio.gov/) or the responsible federal program. Plan type, funding, jurisdiction, and denial category can change the process.
Is the independent-review decision binding?
The effect of a decision depends on the external-review authority and the plan governing the case. Confirm the consequence in the current notice and applicable source.
Can I request expedited external review?
An expedited route may exist when delay would seriously jeopardize life, health, function, or recovery. Seek urgent medical help when needed and verify the route and timing with the responsible authority.
Does external review cost anything?
Most state IRO processes are FREE to consumers. Plans pay the IRO fee.
Other Ohio resources
Sources
File with Ohio insurance department
Ohio's designated external review process: https://insurance.ohio.gov/consumers/complaints
Get started →Contact: hello@denialhelp.com