External Review – RHODE ISLAND

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

You can contact the Rhode Island Insurance Division at (401) 462-9520. The Division is open from 8:30 a.m. to 4:00 p.m., Monday through Friday.

What happens after the Division receives my complaint?

Once the Insurance Division receives your complaint, it will determine whether it can handle your claim.[21] If it decides to handle your claim, it will send you an acknowledgement letter. It will also send a copy of your complaint to your...

How do I file a complaint?

If you are a Rhode Island resident, you can file a complaint with the Rhode Island Department of Business Regulation, Insurance Division, if your claim is denied after the external review process and you believe that your health insurer has...

How long will the external review process take?

The external review agency should send you its decision within ten business days from receiving the necessary documentation.[15] If you request an expedited external review, the process takes no longer than two business days.[16]

How do I request an external review?

You should submit your request for an external review to your health insurer within 60 days from the date that your insurer sent you the final decision.[10] You must also send your insurer a check for half of any fee required.[11] The...

In what circumstances can I apply for an external review?

During an external review, an independent third party reviews your insurer’s decision.[9] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Rhode Island law entitles you to request an external review...

How long should the internal appeals process take?

The first level and second level internal appeals process should take a maximum of 21 business days for each level of appeal.[7] An expedited internal appeal should be completed within two business days after the appeal is filed and the insurer...

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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