Pennsylvania Insurance Appeal Laws & Rights

Pennsylvania's Insurance Department provides consumer protection for insurance appeals, with external review available for health plan denials and specific protections under Act 68 for managed care consumers.

Regulatory Agency

Pennsylvania Insurance Department (PID)

Phone: 1-877-881-6388
Website: insurance.pa.gov

Key Protections

Act 68 managed care protections
External review (CertifiedERO) for medical necessity denials
Bureau of Consumer Services complaint process
Mental health parity enforcement
Prompt pay requirements

Appeal Timeline
Step Deadline
Internal appeal (first level) 30 days (HMO)
Internal appeal (second level) Available for HMO
External review 15 days after final denial
| PID complaint | No deadline |

Step	Deadline
Internal appeal (first level)	30 days (HMO)
Internal appeal (second level)	Available for HMO
External review	15 days after final denial

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Frequently Asked Questions

How do I file an insurance complaint in Pennsylvania?

Contact the Pennsylvania Insurance Department's Bureau of Consumer Services at 1-877-881-6388 or file online at insurance.pa.gov. They handle complaints and can assist with appeal procedures.