During an expedited external review, an independent third party reviews your insurer’s decision.[6] You can request an external review of the insurer’s decision in the following circumstances:

  • You requested an internal appeal, but your insurer did not provide you with a decision within 30 days;[7]
  • Your insurer denied you coverage after you requested an internal appeal; or
  • You your situation is urgent situation (request an expedited external review).[8]

You can obtain the external review packet online here. This packet contains forms for both standard and expedited external reviews. Be sure to include the following information in your application:

  • The name, address, telephone number, and email address of the patient;
  • The name, address, telephone number, fax number, and email address of the insurance company;
  • The employer’s name;
  • The name and address of the treating health care provider, as well as the name, telephone number, and email address of the contact person; and
  • The reason for the health insurer’s denial.

You should submit the following supporting documents with your completed external review request:

Signed medical records release form (included in packet); AND

  • Any documentation not previously submitted during the internal appeal process; AND
  • Final determination letter from the health insurer; OR
  • Letter from health insurer stating it has waived the internal review process; OR
  • A copy of the request for internal appeal and a statement that no decision has been received for 30 days; OR
  • A completed request for expedited review (included in packet).[9]

If you are requesting a standard external review, you can submit the form and copies of all supporting documents by fax to (515) 281-3059, by email to [email protected], or by mail to:

Iowa Insurance Division
330 Maple
Des Moines, IA 50319[10]

If you are requesting an expedited external review, you must call the Iowa Insurance Division at (877) 955-1212 or (515) 281-6348 to receive instructions on the quickest way to submit the form and supporting documentation.[11]