External Review – DELAWARE

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

You can contact the Delaware Department of Insurance at (302) 674-7310 or (800) 282-8611. The Department is open from 8:00 a.m. to 4:30 p.m. Monday through Friday.

What happens after the Department receives my complaint?

The Department of Insurance will assign someone to investigate your complaint.[13] The That representative may question witnesses, request additional documents from other parties, and hold a hearing.[14]

How do I file a complaint?

If you are a Delaware resident and your insurer denies your coverage after the external review process, you can file a complaint with the Delaware Department of Insurance (“Department”). Complaint information. Your complaint should include the following information: The name, age,...

How long will the external review process take?

The external review organization should respond to you within 45 days of receiving the application. If you request an expedited external review, the process should take no more than three business days after your request is received.[10]

How do I request an external review?

You should submit a request for an external review to your insurer by completing an appeals form that your insurer provides to you within four months from the date on the first appeal denial letter.[6] Be sure to inform your insurer...

In what circumstances can I apply for an external review?

During an external review, an independent third party reviews your insurer’s decision.[3] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Pursuant to Delaware’s Independent Healthcare Appeals Program, you are entitled...

How long should the internal appeals process take?

The internal appeals process should take a maximum of 45 days from the date that the insurer received your request for appeal.[2]

How do I appeal the decision?

If your insurer denies your claim, you have the right to an internal appeal.[1] This means you can ask your insurer to conduct a full and fair review of its decision. To appeal the denial, you should do the following: Review...

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