Illinois external review
Illinois external review assigns your denial to a state-approved Independent Review Organization once you finish your plan's internal appeal — or immediately in urgent situations. It's free, you can file entirely online or even by plain email, and when the IRO reverses the denial your insurer must approve the coverage immediately.
Deadlines and decision timelines
- Your filing window: 120 days from the final internal denial.
- Standard review decided in: 5 days after the IRO has all necessary information, never more than 45 days total
- Expedited review decided in: 72 hours — urgent situations and experimental/investigational denials, with your treating provider completing the certification form
- Cost to you: None
How to file, step by step
- Finish your plan's internal appeal. External review generally requires a final adverse determination from your insurer first. Urgent cases can skip ahead — file the expedited request right away.
- Complete the IDOI external review request form. Attach your denial letter and anything that supports medical necessity — physician letters, records, guidelines.
- Submit it your way. Online through the IDOI Message Center (idoihelpcenter.illinois.gov), by email to DOI.externalreview@illinois.gov, by fax to (217) 557-8495, or by mail to IDOI, 320 W. Washington St., Springfield, IL 62767.
- The IRO reviews and decides. A decision comes within 5 days of the IRO receiving complete information — no more than 45 days total, or 72 hours on the expedited track.
Who can use it
- Fully-insured plans, for denials involving medical judgment, experimental or investigational determinations, pre-existing conditions, or rescission.
- Not eligible: self-insured employer, union, church, or non-federal governmental plans — those use the federal external review process instead.
What to know
- 4 months from the final internal denial to file — don't wait for a better moment.
- In an expedited review, if your insurer fails to hand records to the IRO within 24 hours, the IRO can terminate the review and reverse the denial outright.
- When the IRO reverses, Illinois law requires the insurer to approve the coverage immediately (215 ILCS 180/35).
Denial data from plans operating in Illinois
| Insurer | Contract / plan | Line | Requests | Denied | Appeals overturned |
|---|---|---|---|---|---|
| Centene | H1416 Wellcare | Medicare Advantage | 106,623 | 16.19% | 94.97% |
| Centene | H5779 Wellcare | Medicare Advantage | 14,880 | 16.63% | 95.14% |
| Molina Healthcare | IL-MEDICAID | Medicaid | — | 14% | 52% |
| Molina Healthcare | H8046 | Medicare Advantage | — | 10% | 49% |
| Molina Healthcare | H2715 | Medicare Advantage | — | 5% | 67% |
Illinois external review FAQ
Does an Illinois external review cost anything?
No. There is no cost to the consumer to file an external review in Illinois — the insurer bears the cost of the review.
How fast is the decision?
Standard reviews are decided within 5 days after the Independent Review Organization receives all necessary information, and never more than 45 days from your request. Expedited reviews for urgent care are decided within 72 hours.
Can I file online?
Yes. Illinois accepts external review requests online through the IDOI Message Center, by email, by fax, or by mail — one of the most flexible filing setups in the country.
What if my employer plan is self-funded?
Self-insured employer, union, church, and non-federal governmental plans are outside Illinois's process. Those denials go through the federal external review process instead — check your denial letter for federal filing instructions.
Primary sources
- IDOI — File an External Review
- 215 ILCS 180/35 — standard review timelines
- 215 ILCS 180/40 — expedited review