Compliance Notices.

Carriers

Companion Life Individual STM/LMB Products

Renaissance Dental Individual Products

North River Insurance Individual STM/LMB Products

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Federal

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State Information

Short-Term Medical Universal Appeal Notice

Arizona

Consumer Guide to the Health Care Appeals Process in Arizona

Arkansas

External Review Medical Claims Frequently Asked Questions

External Review Request Form

California

Independent Medical Review (IMR) Program

Application for Independent Medical Review

Colorado

When Your Health Insurance Carrier Says NO: Your Rights Regarding Pre-Authorization and Appeal Procedures

Connecticut

Insurance Department Appeals & External Review Guide

Request for External Review

District of Columbia

Consumer Notice

Delaware

Procedure for IHCAP applications

Insurer's Petition for External Review: Delaware's Independent Health Care Appeals Program

Iowa

External Review Request Form

Idaho

External Review FAQ

Health Claims External Review Request Form

Illinois

Fact Sheet: External Review

Request for External Review

Kansas

Independent Medical Review

Kentucky

Appealing a Denial From Your Health Benefit Plan - Expanded Version

Louisiana

Understanding Your Healthcare Rights

Bulletin 2014-08: External Review Process Effective on January 1, 2015

Massachusetts

Request for Independent External Review of a Health Insurance Grievance Through the Office of Patient Protection

Maine

Consumer Guide to Health Insurance Appeals

Requesting an External Review for Health Insurance

Michigan

How to Appeal a Decision Made by Your Health Insurer

Health Care Appeals - Request for External Review

Minnesota

Help is available if a health insurance company denies your claim

Health insurance external review appeal

Missouri

External Review Process

Consumer Complaint Report

Mississippi

External Review Request Form

Montana

How it Works: The Internal Appeal Process

North Carolina

Medical Appeals Tool Kit

Health Insurance Utilization Review, Appeals and Grievances and External Review

Have You Had a Health Claim Denied?

A Consumer's Guide to External Review

External Review Request Form

North Dakota

External Review Summary

Complaint Questionnaire

Nebraska

Appealing a Health Plan Decision

External Review Request Form

New Hampshire

Appeals & External Reviews: Quick Facts and Information for Granite Staters

Consumer Guide to External Appeal

Independent External Review: Appealing a Denied Medical or Dental Claim

New Jersey

Appeal and Complaint Guide for New Jersey Consumers

External Appeal Application

New Mexico

Summary of Health Insurance Grievance Procedures

Complaint Form

Nevada

Internal Claims and Appeals, and External Review Processes Under the Affordable Care Act

External Review Request Form

Ohio

Model External Review Procedures Summary

Model External Review Request Form

Oklahoma

External Review Process

External Review Request Form

Oregon

Department of Consumer and Business Services

Consumer Guide to Health Insurance Appeals

Pennsylvania

Filing Health Insurance Appeals

South Dakota

Standard External Health Review Process

South Dakota External Review Application

Texas

Independent Review Organization FAQs

Request for a Review by an Independent Review Organization (IRO) Instructions

Utah

Independent Review of an Adverse Benefit Determination

Independent Review Request

Virginia

Independent External Review

External Review Request Form

Vermont

Healthcare External Appeal

Wisconsin

Fact Sheet on the Independent Review Process in Wisconsin

West Virginia

Guide to External Review Process

Wyoming

Insurance Claim Denial External Review Process

External Review Request Checklist - What to Send and Where to Send it