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State guide

New Hampshire

Pick the kind of plan you have to see who to call first. New Hampshire can only help with plans it regulates.

On this page 8

Which plan do you have? Who to call first, by coverage

The short version for New Hampshire

New Hampshire gives you 180 days, longer than most states, to ask the Insurance Department for a free independent external review, and the review also covers dental plans. The Insurance Department's Consumer Services unit doubles as the state's consumer assistance program. State law also sets short clocks on drug exception and prior authorization requests, which are treated as approved if the plan is late.

At a glance: independent review for plans New Hampshire regulates

This box is for insurance you buy, or an employer plan bought from an insurer. It is not for Medicaid, Medicare or a plan your employer funds itself.

Main regulator
New Hampshire Insurance Department · (800) 852-3416 (in-state toll free) or 603-271-2261
Independent review
A state process (Independent External Review (also called External Health Review or Independent External Appeal))
Deadline to request it
180 days after the insurance company's final denial
Cost
none
Decision time
up to 60 days; fast track: 72 hours

Your own notice states the deadline and process for your plan, and controls if it differs. Plans your state does not regulate (for example job-based plans the employer funds itself) follow federal rules; see who regulates your plan.

Who regulates health plans

The Insurance Department says that if you are uncertain which type of benefit plan you have (fully insured, self-insured or self-funded), you should contact your human resources department or your insurance carrier. Self-funded employer or union plans are outside state jurisdiction; for those the Department points to the US Department of Labor at 866-444-3272.

Independent (external) review

Process
A state process. Run by New Hampshire Insurance Department, which certifies the independent review organizations that decide the cases.
Where you file
regulator
How
Download the External Health Review Form from the Insurance Department's Independent External Review page and send it to the Department by email or mail. For an expedited (fast) review your provider must also sign the Provider Certification Form. Call 800-852-3416 to speak with a Consumer Services Officer if you need help.
Which denials qualify
Denials of a recommended service or treatment on the basis that it does not meet the insurer's requirements for medical necessity, appropriateness, health care setting, level of care or effectiveness. Applies to fully insured health or dental plans.
Appeal to the plan first?
Yes for a standard review: you must have completed the insurer's internal appeal process and received a final denial. Exception: an expedited external review may be requested and processed at the same time as an expedited internal appeal when your provider certifies that delay would seriously jeopardize your life, health or ability to regain maximum function.

Official page

General rules and what to send: how external review works, how to request it.

Free help in New Hampshire

Medicare and Medicaid in New Hampshire

Medicare counseling
New Hampshire State Health Insurance Assistance Program (SHIP), ServiceLink Resource Center · 1-866-634-9412 . Free help with Medicare appeals.
Medicaid agency
New Hampshire Department of Health and Human Services (New Hampshire Medicaid), Administrative Appeals Unit
Fair hearing deadline
Generally 30 days from the date on the Notice of Decision for decisions made by the Department. For a denial by a Medicaid managed care plan, 120 calendar days from the date of the plan's notice resolving your appeal. Your notice states the deadline that applies to you.
Good to know
If you are in a Medicaid managed care plan you must finish the plan's own appeal before asking the state for a fair hearing. Appeal requests generally must be in writing and can be mailed to the Administrative Appeals Unit, dropped at a District Office, or emailed to dhhs.aau@dhhs.nh.gov. Read your Notice of Decision carefully for the exact deadline.

Medicaid appeals page How Medicaid appeals work

State laws that can help

  • Prior authorization. A plan that requires prior authorization for a covered drug on its formulary must answer within 2 business days of a complete request, or the prescription is treated as approved.

    New Hampshire Revised Statutes Annotated (RSA) 420-J:7-b, paragraph II-b

  • Step therapy. A plan that sets the order in which drugs must be tried may not make a continuously enrolled patient fail on the same medication more than once.

    RSA 420-J:7-b, paragraph II-a

  • Other. Plans must run a fast exception process, no longer than 48 hours, for medically necessary drugs that are not on the formulary; if the plan takes longer the prescription is treated as approved.

    RSA 420-J:7-b, paragraph II

  • External review. State law gives people in fully insured health and dental plans a free independent external review, with 180 days to ask.

    RSA 420-J:5-a to 420-J:5-e

State laws usually reach only plans your state regulates. They often do not reach job-based plans the employer funds itself.

Sources and what we could not confirm

Read from official pages on . Phone numbers and deadlines change; check the official page before you rely on one.

  1. Independent External Review | New Hampshire Insurance Department
  2. Understand Health Insurance Claim Appeals | New Hampshire Insurance Department
  3. Health Insurance | New Hampshire Insurance Department
  4. Filing a Complaint | New Hampshire Insurance Department
  5. New Hampshire Consumer Assistance | Centers for Medicare & Medicaid Services
  6. Affordable Care Act: Working with States to Protect Consumers (state external review list) | Centers for Medicare & Medicaid Services
  7. New Hampshire | State Health Insurance Assistance Programs
  8. Administrative Appeals | New Hampshire Department of Health and Human Services
  9. N.H. Admin. Code He-W 506.09, Department Fair Hearing Process | Legal Information Institute
  10. RSA 420-J:7-b Prescription Drugs | New Hampshire General Court
  11. RSA 420-J:5-b Standard External Review | New Hampshire General Court
Not confirmed (5)
  • The independent review request form. the Insurance Department page links to the External Health Review Form and Provider Certification Form, but the site blocks automated page loads and the link addresses could not be captured
  • How to file for independent review. the email and mailing address for sending the form were not captured from the official page
  • The Medicaid fair hearing deadline. the 120-day managed care deadline was read in the state rule He-W 506.09 on a legal reference site and on a health plan's member page, not on a Department page
  • Not confirmed. stateLaws (surprise-billing) — New Hampshire's earlier balance billing statute, RSA 329:31-b, shows as repealed effective January 1, 2025; the provision that replaced it was not confirmed, so no surprise billing law is listed
  • Not confirmed. stateLaws (external-review) — only RSA 420-J:5-b was read; the 180-day deadline and the no-cost rule come from the Insurance Department page

Sources last checked . Found a mistake? Report it.