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External Review of Denied Medical Necessities
When a disagreement occurs between insurance companies and their insured consumers (or sometimes the provider on a consumer’s behalf), insurance companies usually offer an opportunity for an internal review of that denied claim. If a consumer has exhausted all internal appeal opportunities with their insurance company, a consumer may request that an external (outside of the insurance company) review entity determine if the consumers claim should be approved. Requests for external review should be through the Iowa Insurance Division.
The Iowa Insurance Division offers consumers the opportunity for external review determining a medical necessity. This review is offered to consumers who have exhausted all internal appeals and is conducted by an independent review entity. The cost is $ 25 and will be returned if the review results in favor of the consumer.
Medical Service Not Considered for External Review
• Credit
• Disability Income Insurance
• Supplements to Liability Insurance
• Vision
• Workers Compensation
• Auto Medical Insurance Payments
Steps for Requesting an External Review
1) Copy the written notice from your insurance company, that states that all appeals have been exhausted (the denial notice).
2) Provide in a letter an explanation of the problem and request for external review. Include in your letter your:
• address
• daytime phone number
• insurance company name, and
• policy number.
3) Submit your company's denial notice, your request letter, supporting documentation, and a check (or money order) for $25 made payable to the Iowa Insurance Division to:
External Review
330 Maple Street
Des Moines, Iowa 50319