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Division of Insurance
External Review - Health Insurance/Major Medical
Filing an External Review
When you have gone through all your options to appeal a denial of coverage or benefit, you may have the right to an External Review. An External Review means an organization not connected with your insurance company reviews your complaint and makes a decision.
Your insurance company is required to notify you of your options regarding the External Review process when they send notice of their final decision about your complaint.
In order to be eligible, you must file within four months of the denial. The cost is $25 and will be refunded to you if the Independent Review Organization's decision is in your favor.
The forms, along with the required information checklist, can be found below (in Adobe .pdf format*). The External Review process can take up to two months to complete.
The Division of Insurance is in charge of the External Review process. If you have any questions, please contact the Division.
Resources for Filing an External Review
External Review Checklist and Request Form
External Review Request Form for Use with Expedited Review Only
External Review Request Form for Use with Experimental/Investigational Denials Only
External Review Process Information for Companies
Independent Review Organizations