You should submit your request for an external review to the South Dakota Division of Insurance within four months from when your insurer sent you the final decision.[8]

Information. You can find a copy of the external review request form here. Your request should include the following information:

  • The name of the applicant;
  • The name, address, email address, and telephone number of the insured/patient;
  • The name and address of the insurance company;
  • The name, email address, and telephone number of the insurance company contact person;
  • Insurance identification number and claim/reference number;
  • The name and telephone number of your employer;
  • The name and address of your health care provider;
  • The name and telephone number of the contact person at your health care provider’s office;
  • Your medical record number;
  • Reason for health care denial; and
  • Summary of external review request.[9]

Supporting documents. You should include the following documents with your request:

  • A filing fee of $25 (check or money order) made payable to the South Dakota Division of Insurance;
  • A copy of your insurance card or other evidence of coverage;
  • Final determination letter from your health insurer;
  • Copy of certificate of coverage or insurance policy benefit booklet;
  • Any relevant medical records;
  • Information from your health insurer related to the denial;
  • Any relevant peer literature or clinical studies;
  • Any additional information from your health care provider; and
  • Any new documentation or information not previously submitted during the grievance process.[10]

Submitting a standard external review. If you are requesting a standard external review, you should submit your request to the following address:

South Dakota Division of Insurance
124 S. Euclid Avenue, 2nd Floor
Pierre, SD 57501-3185[11]

Submitting an expedited review. If you are requesting an expedited external review, call the Division of Insurance at (605) 773-3563 for instructions on submitting your request.[12]