If insurer has denied your health claim, you can submit a request for an independent medical review to the Department of Insurance within 120 days of receiving a final decision from your insurer.[11] You should contact the Kansas Department of Insurance (“Department”) at (800) 432-2484 to request a copy of the Independent Medical Review request form.[12] Note that the following plans are not eligible for independent medical review:

  • Medicare or Medicare supplement
  • Medicaid
  • Federal employee plans
  • Workers’ compensation
  • Self-insured employer plans

Supporting documents. You should include the following supporting documents with your request if your plan is eligible:

  • A letter summarizing your dispute,
  • Any new documentation that you had not included with your previous request for an internal appeal;
  • Copies of relevant medical records;
  • Your health care provider’s professional recommendation;
  • Consulting reports from other health care professionals and other documents submitted by your health insurer, you, or your health care provider;
  • Your insurance policy; and
  • All correspondence sent to you by your insurer[13]

How to submit a standard external review request. To request a standard external review, mail the form and supporting documentation to:

Kansas Department of Insurance
Attn: Consumer Assistance Division
420 SW 9th Street
Topeka, KS 66612

How to submit an expedited external review request. To request an expedited external review, contact the Department at (800) 432-2484 and ask for an independent medical review coordinator to help you with the process.[14]

Within ten business days of receiving your request for external review, the Department will determine whether your situation qualifies for review by an independent review organization.[15] If your request is approved, the Department will forward your request to an independent review organization for further examination.[16]