External Review – WASHINGTON, D.C.

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

If you have questions regarding filing a complaint, you can contact the Department at 202-727-8000 or you can email them at [email protected]. The Department is open from 8:15 a.m. to 4:45 p.m., Monday through Friday.

What happens after the Department receives my complaint?

The Department will look into your complaint to see if any District laws or procedures have been violated.[18] A representative will contact your insurance company to obtain information and an explanation from the insurer.[19] Most complaints are investigated and resolved within 45...

How do I file a complaint?

If you are a resident of the District of Columbia and your claim is denied after the external review process, you can file a complaint with the Department of Insurance, Securities and Banking (“Department”). Complaint information. You can find the...

How long will the external review process take?

The external review process should take a maximum of 45 calendar days to complete.[13] An expedited external review should be completed within 72 hours.[14]

How do I request an external review?

You must file your request for an external review with the District of Columbia Office of Health Care Ombudsman and Bill of Rights within four months of the date on your insurer’s most recent decision. Information. You can find a...

In what circumstances can I apply for an external review?

During an external review, an independent third party reviews your insurer’s decision.[7] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Under District of Columbia law, you are entitled to request...

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 requested service or treatment but are waiting...

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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