Idaho Launches New Health Coverage Denial Appeal Process

December 29, 2009

The Idaho Department of Insurance is notifying the public about the new process to aid the state’s consumers in appealing health insurance claims denied by their insurance carriers. The Idaho Health Carrier External Review Act becomes effective January 1, 2010.

Department Director Bill Deal says, “Consumers should know that if their health claim is denied for ‘medical necessity’ or as an ‘investigational’ service or supply, they may have the right to have an independent review of that decision.”

Information about the review process, including the application for external review, is available on the Department’s Web site, www.doi.idaho.gov. The appeal process is available for denied claims on policies written or renewed on or after January 1.

Consumers wishing to use the review process must complete their health carrier’s internal appeal process before submitting a request to the Department. The carrier’s appeal process is explained in the insurance policy or coverage booklet. After the insurer’s final denial, the external review will be performed at no cost to the consumer by an independent review organization that is separate from the insurer.

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