Who should I call if I have any questions?

If you have questions regarding insurance appeals, you can contact the Utah Department of Insurance at (801) 538-3890 or (800) 439-3805 (in-state). The Department is open from 8:00 a.m. to 5:00 p.m. Monday through Friday. If you have questions regarding...

What happens after the Attorney General’s Office receives my complaint?

The Attorney General’s Office will forward a copy of your complaint to the insurance company and request a response. The insurer has ten days to respond to the complaint. The complaint process typically takes between three and six weeks to...

How do I file a complaint?

If you are a Utah resident and your claim is denied after the external review process, you can file a complaint with the Utah Attorney General’s Office. Complaint information. Your complaint should include the following information: The name, address, email address,...

How long with the external review process take?

The external review process should take no more than 45 days after the independent review organization is assigned to your case.[9] 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 either your health insurer or the Utah Department of Insurance (“Department”) within 180 days of your insurer’s last denial letter.[5] You can find a copy of the Health Benefit Plan Independent...

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. Under Utah law, you are entitled to request an external...

How long should the internal appeals process take?

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 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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