What to Do When a New York Insurer Denies Rehab

A denial letter is not the end of the conversation. In New York it is closer to the beginning of one — and the state gives you more leverage at this exact moment than almost anywhere else in the country.

Here is the part most people never find out in time: if the denial involves inpatient substance use disorder treatment, and an expedited appeal is filed within twenty-four hours, your insurer is legally barred from cutting off coverage while that appeal is decided. Treatment continues. Paid. That protection expires quickly and quietly, and nobody at the plan is going to volunteer it.

This guide walks through exactly what to do, in order, from the hour the denial arrives through the binding external appeal that can overturn it. It covers rehab insurance denial appeals for commercial plans, self-funded employer plans, and New York Medicaid managed care, because the deadlines and the forms are different for each and the wrong process costs you weeks you may not have.

The Recover is a referral network of licensed, independent treatment providers — not an insurance company, law firm, or medical facility. Our admissions team handles benefit verification and appeal coordination with treatment centers every day. If you want a person to walk this with you, call or start with our insurance and rehab guide.

Start Here: The 24-Hour Window That Keeps Treatment Paid

New York Insurance Law § 4904 contains a provision that has no real equivalent in most states. If you or your provider file both an expedited internal appeal and an expedited external appeal within twenty-four hours of receiving an adverse determination on inpatient substance-related and addictive disorder treatment, the utilization review agent may not deny that treatment on medical-necessity or prior-authorization grounds while either appeal is pending. The statutory language is direct: the agent “shall not deny… such substance-related and addictive disorder treatment while a determination… is pending.” Read it yourself at N.Y. Insurance Law § 4904.

Translated into what it means on a Tuesday afternoon when someone is eleven days into residential treatment and the plan says it will not authorize day twelve: file both appeals inside twenty-four hours and the plan keeps paying while the appeals run. Miss the window and you are arguing about a bill instead of protecting a bed.

Two details decide whether you get this protection:

• Both appeals, not one. An expedited internal appeal alone does not trigger it. The external appeal has to go in too, which feels premature — you have not lost the internal appeal yet — but that is how the statute is written and it is deliberate.
• Twenty-four hours from receipt of the adverse determination. Not twenty-four business hours. If the denial lands Friday at 4 p.m., the clock does not pause for the weekend.

This is also why the single most useful thing you can do in the first ten minutes is call the treatment center’s utilization review department rather than the insurer. Facilities that handle New York plans regularly know this rule, have the forms on hand, and can file both appeals same-day with clinical documentation attached. A family member filing alone at 9 p.m. is at a real disadvantage. Loop in the facility first.

What to say when you call the plan

Ask for these four things, and write down the name of whoever you speak with plus the reference number:

1. A copy of the written adverse determination, sent today, by email or fax if possible.
2. The specific clinical criteria used to deny, by name. In New York this should be LOCADTR 3.0 or an alternative tool approved by the Office of Addiction Services and Supports.
3. The name and credentials of the clinical peer reviewer who made the decision, and confirmation that the reviewer has substance use disorder training and experience.
4. Written confirmation that you are requesting an expedited internal appeal, effective as of this call, and the fax number and portal address for filing.

That fourth item matters because oral requests get lost. Follow every call with an email or fax the same day that says, in one sentence, that you are requesting an expedited appeal and the date and time of your call. You are building a paper trail that an external appeal reviewer will read later.

Read the Denial Letter First — It Tells You Which Clock You Are On

Not every rehab denial is the same animal, and the deadlines diverge sharply depending on when in the treatment timeline the denial arrives. New York denial notices are required to tell you which type you are looking at, along with the clinical rationale and your appeal rights. If the letter does not contain those things, that omission is itself grounds for a complaint and may let you skip a step.

Type of denial	What happened	How fast the plan must decide your appeal
Preauthorization (prospective)	Treatment denied before it starts	Expedited: 2 business days. 24 hours for inpatient SUD. Standard: 30 days
Concurrent	Treatment underway; plan refuses to authorize further days	Expedited: 24 hours for inpatient SUD when requested at least 24 hours before discharge
Retrospective	Treatment already finished; plan refuses to pay the claim	Standard: 30 days from receipt of necessary information
Administrative	Denied for a non-clinical reason — eligibility, late filing, missing form	Not a medical-necessity denial; usually corrected rather than appealed

That last row is worth a second look before you build a clinical argument. A surprising share of what families experience as a rehab denial is actually a coding error, an eligibility lag after a job change, or a facility that billed the wrong entity. Those get fixed with a phone call, not an appeal. If the letter cites no clinical reasoning at all, ask the plan directly whether the denial is administrative.

If the denial arrived before admission and concerns detox specifically, the mechanics are covered in more depth in our guide to prior authorization for detox in New York. If the denial concerns how many days the plan will approve, how long insurance covers rehab in New York walks through the length-of-stay review process that produces most concurrent denials.

Check Whether the Denial Was Even Legal

Before you argue that treatment is medically necessary, check whether the plan was allowed to make this decision in the first place. New York restricts substance use disorder utilization review more tightly than any other benefit category, and denials that violate those restrictions are not judgment calls you have to win on the clinical merits. They are rule violations you point out.

For plans regulated by New York State, an insurer generally may not:

• Require preauthorization for inpatient SUD treatment at a facility licensed or certified by the New York State Office of Addiction Services and Supports that participates in the plan’s network. The Department of Financial Services states this plainly on its consumer page.
• Require preauthorization for outpatient SUD treatment at a licensed facility.
• Require preauthorization for medications used to treat substance use disorder, including buprenorphine and naltrexone.
• Conduct medical-necessity review during the first 28 days of inpatient SUD treatment, provided the facility notified the plan of the admission and treatment plan within two business days and performs daily clinical review.
• Conduct concurrent review during the first four weeks of outpatient SUD treatment, up to 28 visits, under the same notification conditions.
• Use its own homegrown criteria. New York requires LOCADTR 3.0 — the Level of Care for Alcohol and Drug Treatment Referral tool — or an alternative approved by OASAS. A denial citing proprietary internal guidelines instead is vulnerable.
• Assign a clinical peer reviewer who lacks specialized training and experience in substance use disorder treatment.

The conditions attached to the 28-day protection are where it most often breaks down, and they are the facility’s obligations, not yours: notice within two business days of admission with the initial treatment plan, daily clinical assessments documenting continued need, and consultation with the plan by the fourteenth day. OASAS spells out the mechanics in its implementation and utilization review guidance. If a plan issued a day-nine denial, the first question to ask the facility is whether that two-business-day notice actually went out and whether there is proof.

When one of these applies, say so in the first paragraph of your appeal, cite the provision, and ask for the denial to be withdrawn rather than reconsidered. That is a different and much stronger request than asking a reviewer to change their clinical mind.

Our overview of OASAS-certified treatment in New York explains how to confirm a facility’s certification status, which is a prerequisite for most of these protections.

Which Appeal Process Applies to You

This is the fork in the road, and getting it wrong wastes the one thing you cannot get back. Three different systems govern rehab insurance denial appeals in New York, and your plan type determines which one you are in.

Plans regulated by New York State

Fully insured commercial plans — coverage your employer buys from a carrier, plans purchased on the NY State of Health marketplace, and most union and small-group coverage — are subject to New York Insurance Law. You get the state internal appeal, the 24-hour inpatient SUD protection, and the binding external appeal administered by the Department of Financial Services. This is the strongest position to be in.

Self-funded employer plans

If your employer pays claims from its own funds and merely hires a carrier to administer them, the plan is governed by federal ERISA law and New York’s external appeal law does not reach it. This catches people off guard constantly, because the ID card says Aetna or UnitedHealthcare and looks identical to a fully insured card. You still have strong federal rights, described further down, but the state process is closed to you.

New York Medicaid managed care

Medicaid managed care and HARP enrollees use plan appeals followed by a State Fair Hearing. The deadlines are shorter and one of them is unforgiving, so this has its own section below.

How to tell which one you have

5. Look at your Summary Plan Description or Summary of Benefits and Coverage. Self-funded plans typically include language about the plan being self-insured and the carrier acting only as a third-party administrator or claims administrator.
6. Check the ID card for the phrase “Administered by” rather than “Insured by,” and look for an ERISA notice in your benefits handbook.
7. Call HR and ask one question: “Is our medical plan fully insured or self-funded?” Benefits staff answer this routinely.
8. Ask the plan directly whether the denial is eligible for New York external appeal. If the answer is no, that generally confirms a self-funded or federally governed plan.

If you are not sure what your plan covers before any of this begins, how to check your rehab benefits in New York walks through the verification call step by step, and does insurance have to cover rehab in New York explains which mandates attach to which plan types.

Step 1 — File the Internal Appeal

Every process starts here, with one exception covered below. The internal appeal is the plan reviewing its own decision, which sounds futile and frequently is not: a meaningful share of denials are reversed internally once a clinician actually reads the chart rather than a summary.

Deadlines

• New York Insurance Law requires plans to give you no less than 45 days from receipt of the initial determination to file. Most plans and all non-grandfathered plans under federal rules allow 180 days. Your denial letter states the actual deadline — use that number, and file long before it.
• Expedited internal appeals are decided within two business days of receipt of necessary information, or within 24 hours for inpatient substance-related and addictive disorder treatment when requested at least 24 hours before discharge.
• Standard internal appeals are decided within 30 days of receipt of necessary information.

Who should file

Either you or your provider can file, and in practice the strongest appeals are filed by the treatment center with the patient’s written authorization, because the facility holds the clinical record. File in parallel rather than choosing: you submit the member appeal, the facility submits the clinical appeal, and both reference the same claim number. Duplicate filings are not a problem. Silence is.

What to include

9. The denial letter itself, and the claim or authorization number from it.
10. A signed authorization allowing the facility and any treating clinician to release records and speak with the plan on your behalf.
11. A letter of medical necessity from the treating physician or clinical director addressing the plan’s stated reason directly, point by point.
12. The completed LOCADTR determination supporting the level of care at issue.
13. Clinical records: admission assessment, withdrawal scoring such as CIWA or COWS where relevant, daily progress notes, medication administration records, any co-occurring mental health diagnosis and treatment.
14. Relevant history the plan may not have: prior failed attempts at a lower level of care, prior overdoses, prior withdrawal complications, unstable housing, or an unsafe home environment. This is often the evidence that decides the case.
15. An explicit request for an expedited review, with the clinical reason delay is dangerous.

If the plan denies again, the letter you receive is the final adverse determination. Keep it. It is the ticket to the external appeal, and the external appeal is where the decision stops belonging to your insurer.

Step 2 — File the External Appeal with the Department of Financial Services

New York’s external appeal is decided by an independent review agent, not your plan, and the determination is binding on the insurer and admissible in court. It is administered by the Department of Financial Services and it is the single most powerful tool in this process. Start at the DFS external appeal page.

Element	What applies
Deadline to file	Within 4 months of the final adverse determination (patients). Providers: 60 days
Standard decision	30 days from receipt of the request, plus up to 5 business days if the reviewer requests more information
Expedited decision	72 hours, when your physician attests that delay poses an imminent threat to health
Fee	Up to $25 per appeal, capped at $75 per year. Waived for Medicaid, Child Health Plus, Essential Plan, and financial hardship. Refunded if you win
Required forms	Patient Consent Form with an actual signature, Physician Attestation Form, supporting medical records
Is it binding?	Yes — binding on the plan and admissible in any court proceeding

Filing channels, per DFS: the online portal, which is the preferred route and produces a confirmation you can rely on; email; fax at (800) 332-2729; or mail to the Department of Financial Services, 99 Washington Avenue, Box 177, Albany, NY 12210. If the situation is urgent, use the portal or the fax and then call the DFS consumer hotline at (800) 342-3736 to confirm receipt the same day.

Three practical notes that decide a meaningful number of these cases. First, the Physician Attestation Form is where the expedited designation lives — if your physician does not attest that delay is dangerous, you get the 30-day track by default. Second, the consent form needs a real signature, and a typed name has caused avoidable rejections. Third, the four-month deadline runs from the final adverse determination, not from the original denial, so do not let a slow internal appeal convince you the window has closed.

DFS publishes its past external appeal decisions publicly, searchable by condition and treatment type. Reading a handful of substance use disorder decisions before you write your appeal is genuinely instructive, because the reasoning that persuades these reviewers is consistent and visible: documented failure at lower levels of care, specific withdrawal risk, co-occurring conditions, and a clear statement of what would happen clinically if the requested level of care were denied.

What to Put in a Rehab Denial Appeal Letter

Appeal letters that work are short, specific, and organized around the plan’s own stated reason. Appeal letters that fail are long, emotional, and organized around how much the writer disagrees. Both feelings are legitimate. Only one of them moves a reviewer.

Use six blocks, in this order:

16. Identification. Member name, member ID, claim or authorization number, facility name, dates of service, and the date of the denial letter.
17. The request, in one sentence. “I am requesting an expedited internal appeal and expedited external appeal of the adverse determination dated [date] denying continued residential treatment.”
18. The rule, if a rule was broken. “This admission is to an OASAS-certified facility participating in the plan network. Under New York law, preauthorization may not be required and medical-necessity review may not be conducted during the first 28 days. I am requesting that the denial be withdrawn.”
19. The clinical rebuttal. Quote the plan’s stated reason, then answer it with specifics from the record. If the denial says the patient can be safely managed at a lower level of care, name the lower levels already attempted, when, and how they ended.
20. The risk of denial. State plainly and clinically what is likely to happen if coverage stops: withdrawal complications, relapse with elevated overdose risk after a period of reduced tolerance, an unsafe discharge environment, destabilization of a co-occurring condition.
21. The attachments list. Number every document so the reviewer can confirm nothing is missing.

One sentence worth including verbatim when it is true, because it forces a documented answer: “Please identify the clinical criteria and the specific LOCADTR determination relied upon, and the name and credentials of the clinical peer reviewer who made this determination.”

Common Reasons Insurers Deny Rehab — and What Answers Each One

Denial language is formulaic. Once you recognize which template you received, you know what evidence the appeal needs.

What the denial says	What it usually means	What to submit
Not medically necessary at this level of care	The reviewer thinks outpatient or PHP would do	LOCADTR determination, documented failures at lower levels, withdrawal risk scores, co-occurring diagnoses
Patient can be safely treated as an outpatient	No documented instability in the chart the reviewer saw	Daily progress notes, vital signs, withdrawal scoring, unsafe home environment documentation
No prior authorization obtained	Often unlawful for NY-regulated plans and OASAS-certified facilities	Cite the preauthorization prohibition; confirm facility certification and network status
Continued stay not authorized beyond [day]	Concurrent review during a protected window, or thin daily documentation	Proof of 2-business-day notice, daily clinical reviews, updated treatment plan and progress toward goals
Out-of-network provider	Plan has no adequate in-network option, or benefits were misread	Network adequacy argument, single case agreement request, out-of-network benefit terms
Custodial or not active treatment	Records read as housing rather than clinical care	Therapy hours, medical oversight, medication management, individualized treatment plan

If the denial turns on network status rather than clinical judgment, the argument changes shape entirely — see out-of-network rehab coverage in New York for how single case agreements and network adequacy arguments work.

If You Have a Self-Funded Employer Plan

New York’s external appeal law does not apply to self-funded ERISA plans — a position the Department of Financial Services has stated in formal guidance. What you have instead is the federal external review process, and it is real.

• Under 45 CFR 147.136, you have four months from the final internal adverse determination to request external review by an independent review organization.
• Standard federal external review decisions come within 45 days. Expedited review, for urgent situations, comes within 72 hours.
• The deemed exhaustion rule matters enormously here: if the plan fails to follow its own internal appeal procedures, you are treated as having exhausted internal appeals and may go straight to external review. Missed deadlines, denials with no clinical rationale, refusal to provide the criteria used, or no clinical reviewer with relevant expertise can all trigger it.
• The U.S. Department of Labor’s Employee Benefits Security Administration takes ERISA complaints and can pressure a plan that is not following its own rules.

The practical difference for someone in treatment right now is the expedited track. Forty-five days is not a timeline anyone in residential care can wait out, so the physician attestation that delay is dangerous is not a formality — it is the whole ballgame. Make sure the treating physician writes it in clinical terms and that it accompanies the request rather than following it.

Parity: When the Pattern Is the Violation

Sometimes the problem is not one denial. It is that the plan treats addiction treatment more restrictively than it treats comparable medical care — reviewing every additional day of rehab while approving a surgical admission without comment, applying step-therapy requirements that have no medical-surgical analogue, or maintaining a behavioral health network so thin that in-network care is theoretical.

Federal parity law and New York parity requirements both prohibit this. The lever most people never pull: you can request the plan’s comparative analysis of its non-quantitative treatment limitations — the plan’s own written demonstration that the way it applies medical-necessity review to substance use disorder benefits is no more restrictive than the way it applies review to medical and surgical benefits. Plans are required to produce this on request. Requesting it in an appeal changes the tenor of the conversation, because it moves the question from your chart to the plan’s compliance.

You do not need to prove a parity violation to raise it. Ask for the analysis, note the pattern you have observed, and send a copy of the request to the Department of Financial Services. Parity complaints receive regulatory attention that individual medical-necessity disputes do not.

Medicaid Managed Care Denials: Different Clocks, One Trap

If your coverage is New York Medicaid managed care or a HARP plan, the process is a plan appeal followed by a State Fair Hearing — and there is one deadline here that catches almost everyone.

• You generally have 60 days from the initial adverse determination notice to file a plan appeal.
• But if you want services to continue while the appeal is decided — aid continuing — you must file the plan appeal within 10 days of the notice or the effective date of the action, whichever is later. Ten days, not sixty.
• Plan appeals are decided within 30 calendar days standard, 72 hours expedited.
• After a final adverse determination you have no less than 120 days to request a State Fair Hearing, per the New York State Department of Health. To keep aid continuing through the hearing, request it within 10 days of the plan’s written appeal decision.

The ten-day rule is the trap. Someone reads sixty days on the notice, takes two weeks to gather records, files on day eighteen — perfectly timely — and discovers that services stopped on day one because aid continuing was never triggered. If treatment is ongoing and the plan has moved to reduce or terminate it, file something within ten days even if your documentation is incomplete. You can supplement an appeal. You cannot resurrect aid continuing.

Free Help — You Do Not Have to Do This Alone

New York funds several programs specifically to help people in this position, and none of them charge anything.

• CHAMP — the Community Health Access to Addiction and Mental Healthcare Project, New York’s behavioral health ombudsman, at (888) 614-5400. This is the most directly relevant resource on this list. CHAMP advocates help with SUD and mental health coverage denials specifically, including appeal preparation.
• The Department of Financial Services consumer hotline at (800) 342-3736, which takes complaints about insurer conduct and administers the external appeal program. Details on the DFS mental health and SUD page.
• The New York Attorney General’s Health Care Bureau Helpline at 1-800-428-9071. Its advocates review documents and contact plans directly on consumers’ behalf, including on denials and prior-authorization disputes. See the Health Care Helpline page.
• The OASAS HOPEline at (877) 846-7369, staffed around the clock for treatment access questions and referrals.
• The treatment center’s own utilization review staff, who do this daily and are usually the fastest route to a filed, documented, clinically supported appeal.

Calling two of these is not redundant. A CHAMP advocate and a facility UR nurse working the same denial from different directions is a good outcome, not a duplicated effort.

What Happens to Treatment While You Appeal

The honest answer depends on which protection you managed to trigger. If you filed the dual expedited appeal within twenty-four hours on an inpatient SUD denial, coverage continues by operation of law. If you are in Medicaid managed care and filed within ten days, aid continuing applies. Outside those two situations, the plan is not obligated to pay during the appeal — which does not mean treatment has to stop.

If you are told to prepare for discharge while an appeal is pending, do these four things before anyone packs:

22. Ask the facility for a written clinical statement that discharge at this time is against medical advice from the treatment team’s perspective, and ask that it go into the record and to the plan.
23. Ask the facility about continuing at a self-pay or sliding-scale rate for the days the appeal is likely to take. Many programs will hold a bed for a short, defined window, particularly when an external appeal is already filed.
24. Ask for a clinically appropriate step-down rather than a discharge home — partial hospitalization or intensive outpatient preserves structure and strengthens the appeal record by documenting continued need.
25. Keep everything. Denial letters, appeal confirmations, call logs with names and reference numbers, discharge paperwork. If the external appeal overturns the denial, this is the documentation that gets the days paid retroactively.

A step-down is a legitimate clinical decision, not a surrender — see partial hospitalization, intensive outpatient, and dual diagnosis treatment for what each level involves. If a co-occurring mental health condition is part of the picture, say so in every appeal document; integrated care is harder for a plan to deny at a lower level.

Frequently Asked Questions

Can I appeal a rehab insurance denial myself, or do I need a lawyer?

You can do it yourself, and most successful appeals involve no attorney. What they do involve is clinical documentation, which is why filing jointly with the treatment center matters more than legal representation. Attorneys become relevant mainly for self-funded ERISA plans after federal external review has been exhausted, or where a plan has ignored its own procedures repeatedly.

How long do I have to appeal a rehab denial in New York?

New York law requires plans to allow at least 45 days to file an internal appeal, and most plans allow 180. The external appeal must reach DFS within four months of the final adverse determination. But if inpatient SUD treatment is underway, the deadline that actually matters is twenty-four hours, because that is the window for the protection that keeps coverage in place during the appeal.

What are the odds an appeal works?

Better than most people assume, and highly dependent on documentation quality. Internal appeals are reversed with some regularity when a clinician reviews the full chart rather than a summary. External appeals are decided by independent reviewers with no financial stake, and the determination binds the insurer. Denials that rest on a New York rule the plan was not permitted to apply are the strongest cases of all.

Does filing an appeal cost anything?

Internal appeals are free. New York external appeals carry a fee of up to $25, capped at $75 per year, waived for Medicaid, Child Health Plus, Essential Plan, and financial hardship — and refunded if you win. Federal external review for self-funded plans is free to the claimant.

My insurer says rehab needs prior authorization. Is that allowed?

Frequently not. For plans regulated by New York State, preauthorization generally may not be required for inpatient SUD treatment at an OASAS-certified in-network facility, for outpatient SUD treatment at a licensed facility, or for SUD medications. If you received a denial on prior-authorization grounds in one of those situations, the appeal should ask for the denial to be withdrawn as improper rather than reconsidered.

The plan approved 7 days and denied day 8. Can they do that?

Not during a protected window. If the facility is OASAS-certified, notified the plan within two business days of admission with the treatment plan, and performs daily clinical review, the plan generally may not conduct medical-necessity review for the first 28 days of inpatient SUD treatment. Ask the facility for proof the notification went out — that document decides the appeal.

What is an external appeal and who decides it?

It is a review by an independent agent certified by the Department of Financial Services, entirely outside your insurer. The reviewer examines the clinical record and the criteria applied, and issues a determination that is binding on the plan and admissible in court.

Can the treatment center appeal for me?

Yes, and it usually should, alongside your own member appeal. Providers can file external appeals too, though on a tighter 60-day deadline and with a separate $50 fee that is refunded if the denial is overturned. Filing in parallel is the strongest approach.

What if my employer plan is self-funded?

New York’s external appeal does not apply, but federal external review does: four months to file after the final internal denial, 45 days for a standard decision, 72 hours expedited. And if the plan failed to follow its own appeal procedures, deemed exhaustion may let you skip internal appeals entirely.

Does an appeal stop the discharge?

Only if you triggered a coverage-continuation protection — the twenty-four-hour dual expedited appeal for inpatient SUD, or aid continuing in Medicaid managed care. Otherwise, ask the facility about a short self-pay bridge or a clinically appropriate step-down while the appeal is decided, and document everything for retroactive payment if you win.

I already paid out of pocket after a denial. Is it too late?

No. Retrospective denials can be appealed, and a successful external appeal can produce reimbursement for care already delivered and paid for. Keep every bill, receipt, denial letter, and clinical record. The four-month external appeal clock runs from the final adverse determination.

The Next Step

Denial letters are written to sound final. They are not. In New York they are the start of a process that includes an independent reviewer whose decision your insurer has to follow — and, if the treatment is inpatient and you move within a day, a legal protection that keeps the bed paid for while that plays out.

You do not need to understand all of this before you act. You need to know which of the three systems you are in, whether you are inside the twenty-four-hour window, and who is filing. A verification specialist can establish all three in one call, coordinate with the facility’s utilization review team, and get the appeal moving today.

If treatment has not started yet and you are trying to avoid a denial rather than overturn one, start with our insurance and rehab guide, then find New York treatment options or browse treatment centers near you. For level-of-care specifics, see medical detox and residential rehab.

Authoritative Sources

• New York State Department of Financial Services — File an External Appeal
• NYS DFS — Mental Health and Substance Use Disorder Information
• N.Y. Insurance Law § 4904 — Appeal of Adverse Determinations by Utilization Review Agents
• N.Y. Insurance Law § 4914 — Procedures for External Appeals of Adverse Determinations
• NYS OASAS — Level of Care Determination (LOCADTR)
• NYS OASAS — Implementation and Utilization Review Guidance
• NYS DFS — Insurance Circular Letter No. 14 (2017)
• 45 CFR 147.136 — Internal Claims and Appeals and External Review Processes
• NYS Department of Health — Right to Fair Hearing and Aid Continuing
• New York State Attorney General — Health Care Helpline
• SAMHSA — FindTreatment.gov