You should submit your request for external review to the Ohio Department of Insurance (“Department”) within four months from the date that your insurer sent you the final decision.[6]

Information. You can find a copy of the request form here. You should include the following information with your request:

  • The name of the applicant;
  • The name of the insured;
  • The name, address, and telephone number of the patient;
  • The name, address, and telephone number of the insurance company;
  • Insurance identification number and insurance claim/reference number;
  • The name and telephone number of the employer;
  • The name and address of your treating healthcare provider;
  • The name and telephone number of the contact person with your healthcare provider;
  • Your medical record number;
  • The reason for the denial;
  • A description of the disputed decision; and
  • The health care provider certification form found on page 6 of the request packet (this step is only for expedited external review requests).[7]

Supporting documents. You should also include the following documentation:

  • A signed medical record release form (included in the external review form packet);
  • A copy of your insurance card;
  • A copy of the final determination letter from your health insurer;
  • A copy of your certificate of coverage or insurance policy benefit booklet; and
  • Any additional or new information and documentation not included with your request for an internal appeal.[8]

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

Oklahoma Insurance Department
External Review
Five Corporate Plaza
3625 NW 56th Street, Suite 100
Oklahoma City, OK 73112-4511[9]

Submitting an expedited review. If you are requesting an expedited external review, you should call the Department at (800) 522-0071 or (405) 521-2828 to receive instructions on the fastest way to submit your request.[10]