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 56^th 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]