You should submit your request for an external review to the North Carolina Department of Insurance, Health Insurance Smart NC (“Smart NC”).[19] You must file your request within 120 days from the date that your insurer sent you its final decision.[20]

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

  • The name, address, telephone number, email address, and date of birth of the patient;
  • The name, address, telephone number, email address, and relationship to patient of the person filing the request (if different from the patient);
  • The name, practice type, address, and telephone number of the health care provider;
  • Information regarding the denied service;
  • The name of the insurance company;
  • The name of the insured individual;
  • The member identification number, group number, and name of employer, if applicable; and
  • The name and address of the treating physician and the telephone number and address of the health care practice.[21]

Requesting an expedited review. When you fill out the external review request form, be sure to indicate on page 2 of the form that you are requesting an expedited review.[22] You should include medical records and other supporting information from your health care provider explaining why your case should be expedited.[23]

Supporting documents. You should also include the following documentation:

  • A signed medical record release form (included in the external review request packet);
  • A copy of your insurance card;
  • A copy of the final denial letter from your health insurer;
  • A description of the disagreement; and
  • Any additional or new information and documentation not included with your request for an internal appeal or grievance.[24]

Submitting an external review. If you are requesting a standard external review, you can submit your request online here, fax it to (919) 807-6865, or mail it to the following address:

NC Department of Insurance
1201 Mail Service Center
Raleigh, NC 27699-1201[25]