External Review – GEORGIA

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

You can contact the Georgia Department of Insurance at (404) 656-2070 (in the Atlanta metro area) or (800) 656-2298 (outside the Atlanta metro area). The Department phone lines are open from 8:00 a.m. to 7:00 p.m. Monday through Friday.

What happens after the Department receives my complaint?

The Department will assign an investigator to your case. The investigator will then work with your health insurer and you to resolve the issue.[16] If the investigator determines that the insurer violated a law or policy, it will take corrective action.

How do I file a complaint?

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

How long with the external review process take?

The external review process should take no more than 30 days.[12] If you request an expedited external review, the process should take no longer than 72 hours after your request is received by the independent reviewer.[13]

How do I request an external review?

During an external review, an independent third party reviews your insurer’s decision.[6] You can request an external appeal in the following circumstances: You requested an internal appeal from your insurer, but your insurer did not provide you with a prompt hearing...

What if I can’t wait for an internal appeal because my situation is urgent?

The internal 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 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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