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Compliance Notices.


Carriers

Companion Life Individual STM/LMB Products
Renaissance Dental Individual Products
North River Insurance Individual STM/LMB Products

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
Indiana
For Indiana Residents Who Purchased an Accident and Sickness Product and those covered by a Blanket Accident and Sickness Policy issued in Indiana:
You may at any time ask Us or Our Administrator for an estimate of the amount We will pay for, or reimburse to you, for non-emergency health care services that have been ordered for you. You may also ask Us or Our Administrator for the applicable benefit limitations that apply to the ordered non-emergency health care services you are entitled to receive under your coverage. The law requires that an estimate be provided to you within five (5) business days.

Kansas

Independent Medical Review

Kentucky

Appealing a Denial From Your Health Benefit Plan - Expanded Version

Louisiana

Understanding Your Healthcare Rights

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
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
Request for External Independent Review of a Health Care Decision

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

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