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How do I request an external review?

You should file your request for an external review with the Mississippi Insurance Department (“Department”) within four months from when your insurer sent you the final decision.[4] You can find a copy of the form here.

Information. You should include the following information with your request:

  • The name of the person submitting the application;
  • The name, address, and telephone number of the insured;
  • The name of the patient (if different from the insured individual);
  • The name, address, and telephone number of the insurance company;
  • The insurance identification number and claim number;
  • The name and telephone number of the insured individual’s employer;
  • The name and address of the treating health care provider;
  • The name and telephone number of the contact person at the health care provider’s office;
  • The medical record number;
  • The reason for the denial;
  • A brief description of the claim; and
  • A description of the health care or treatment decision in dispute.[5]

Supporting documents. You should also submit the following supporting documents:

  • A signed medical records release form (included in the external review form packet);
  • A copy of your insurance card or other evidence showing coverage;
  • A copy of the final determination letter from your health insurer;
  • A copy of your insurance policy;
  • Any new information and documentation not included with your original request for an internal appeal; and
  • The health care provider certification form located in the external review packet (this form is for expedited external review requests only).[6]

Submitting a standard external review. If you are requesting a standard external review, you should mail the completed form and supporting documents to the following address:

Mississippi Insurance Department
Attn: Life and Health Actuarial Division
P.O. Box 79
Jackson, MS 39205 [7]

Submitting an expedited review. If you are requesting an expedited external review, you should call the Department at (601) 359-3569 and ask for instructions on the fastest way to submit your request.[8]