External Review – OHIO

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

You can contact the Ohio Department of Insurance at (800) 686-1526. 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?

You should hear from the Department within two weeks with confirmation that it has received your complaint. The confirmation letter will provide you with the name of the analyst handling your complaint, what action the Department plans to take, and...

How do I file a complaint?

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

How long will the external review process take?

The external review process should take no more than 30 days from the date the external review organization receives your request.[15] If you requested an expedited external review, the process should take no longer than 72 hours after your request is...

How do I request an external review?

You should submit your request for an external review to your health insurer in writing by mail, fax, or email.[11] You should include any new information and documentation that you did not previously include with your request for an internal appeal....

How long should the internal appeals process take?

For individual and non-employer group coverage plans, the internal appeals process should take no more than 30 days from the time the health insurer receives all information necessary to review the appeal.[5] For employer group coverage plans, the internal appeals...

In what circumstances can I apply for an external review?

During an external review, an independent third party reviews your insurer’s decision.[8] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Under Ohio law, you are entitled to request an external...

How do I request an internal appeal?

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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