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Denied Health Claims Subject to Review

If you have a health claim denied in Idaho you have the right to the have the decision independently reviewed. This independent review process was instituted as part of Idaho’s Health Carrier External Review Act (Title 41, Chapter 59, Idaho Code) that took effect on January 1, 2010. To be subject to review the claim denial must be based on the health carrier’s decision that a service or supply is not medically necessary or is investigational. The insured must first exhaust the carrier’s internal appeal process and then can request an external review through the Department of Insurance. Information on how to file an external review request is on the Idaho Department of Insurance website.

Read More - Source: Eileen Mundorff, Idaho Department of Insurance Fall 2010 Newsletter


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