My child's CHIP plan denied a service. Can I get an independent review?

Health insuranceComplaint / outside reviewChecked Nov 6, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: GovInfo · 42 CFR 457.1130 Matters subject to review · § 457.1130(b), (c) View original ↗

In short

Yes. A state must give CHIP members an outside review.
It must finish in 90 days. If urgent, 72 hours.
The sources do not give the filing deadline.

What this means

For CHIP, the federal rule says the state must let you ask for an outside review. This covers a delay, denial, cut or end of health care services. It also covers a failure to approve or pay for services on time [1]. The state does not have to give a review if the only reason is a rule that changes coverage for a whole group [1].

A standard external review must be completed within 90 calendar days of the date you request internal (if available) or external review [2]. It must be completed within 72 hours if the enrollee's physician or health plan decides that the standard time could seriously jeopardize the enrollee's life or health [2].

Your next step

Count 90 calendar days for a standard review and 72 hours for an expedited one [2]. The filing deadline is not in these sources: "Don't know yet".

Check it yourself

Your state CHIP office sets the exact steps and the filing time — "Don't know yet" the filing deadline.

Where this comes from (2)

[1] GovInfo · 42 CFR 457.1130 Matters subject to review · § 457.1130(b), (c) · checked 2026-11-06
A State must ensure that an enrollee has an opportunity for external review of a- ( 1 ) Delay, denial, reduction, suspension, or termination of health services, in whole or in part, including a determination about the type or level of services; and ( 2 ) Failure to approve, furnish, or provide payment for health services in a timely manner … A State is not required to provide an opportunity for review of a matter des…
[2] GovInfo · 42 CFR 457.1160 Timeframes · § 457.1160(b)(1)–(2) · checked 2026-11-06
A State must ensure that external review, as described in § 457.1150(b) , is completed within 90 calendar days of the date an enrollee requests internal (if available) or external review … is completed within 72 hours of the time an enrollee requests external review … within 72 hours of the time an enrollee requests external review, if the enrollee's physician or health plan determines that operating under the standa…

How we found this

We matched your question to 2 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-06.

What we don’t know yet

Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.

Every answer is checked against the official rule it quotes.

Information only — not legal advice. Your plan, insurer or agency decides.

This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.

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