How do I file a complaint?

If you are an Arizona resident and your insurer denies your coverage after the external independent review process, you can file a complaint with the Department. Complaint information Your complaint should include the following information: The name, address, email address,...

How long will the external independent review process take?

The external independent review process should take no more than 45 days. If you request an expedited external independent review, the process should take no longer than four business days after your request is received.[15]

How do I request an external independent review?

You should submit your request for a standard or an expedited external independent review to your health insurer, which will then forward the request and all documentation related to your appeal to the Arizona Department of Insurance (“Department”).[13] The Department...

What if my situation is urgent?

Expedited medical review. If your situation is urgent, you can skip the informal reconsideration process and request an expedited medical review.[8] Your situation is urgent if a delay in treatment could cause a significant negative impact on your medical condition. To request...

In which circumstances can I apply for an external independent review?

During an external independent review, an independent third party reviews your insurer’s decision.[5] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. If your insurer denies your claim after conducting a...

How long should the formal appeals process take?

The formal appeals process should take a maximum of 30 days if you have not yet received the requested service or treatment and a maximum of 60 days if you have received the service or treatment but are waiting for...

How do I request a formal appeal?

If your insurer does not require an informal reconsideration or if your insurer denied your claim after the information reconsideration process, you should request a formal appeal (also referred to as an internal appeal). This means you can ask your...

Who should I call if I have any questions about filing a complaint?

If your situation is not urgent and insurer denies your claim, the first step may be to request an informal reconsideration.[1] The informal reconsideration process provides an opportunity for your health care provider and the insurer to discuss your medical condition...

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