External Review – MISSOURI

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

You can contact the Department at (800) 726-7390. The Department is open from 8:00 a.m. to 5:00 p.m. Monday through Friday.

What happens after the Department receives my complaint?

Once the Department receives your complaint, it will send you written confirmation and the tracking number for your complaint.[24] The Department will forward a copy of your complaint to your health insurer and request a response.[25] Your insurer will have 20...

How do I file a complaint?

If your insurer still denies your coverage after the external review process, you can file a complaint with the Department. Complaint information. Your complaint should include the following information: The name, address, email address, and telephone number of the person filing...

How long will the external review process take?

The external review process should take no more than 45 calendar days from the date the external review organization receives your information.[19] If you request an expedited external review, the process should take no longer than 72 hours from when the...

How do I request an external review?

You should contact the Missouri Department of Insurance (“Department”) to request an external review of your case. There is currently no deadline under Missouri law within which to file your request for an external review.[15] You can reach the Department...

What if my insurer denies my coverage after an internal grievance?

If your insurer denies your coverage after the grievance process, you are entitled by law to request an external review from an independent third party, which means your insurer no longer has the final say over whether to approve a...

How long should the internal grievances process take?

A first level internal grievance should take no more than 55 days to complete.[10] A second level grievance should also take no more than an additional 55 days to complete.[11] An expedited grievance request should take no more than 72 hours from...

How do I request a grievance review?

If your insurer denies your claim, you can request a reconsideration of its decision.[1] Your insurer should provide you with a reconsideration decision within one business day.[2] If the insurer denies your claim after the reconsideration process, you have the right...

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