You should submit your request for external review to the West Virginia Offices of the Insurance Commissioner (“Offices”) within 180 days from when your insurer sent you the final decision.[7] You can find a copy of the Independent External Review of Healthcare Decision  form here.

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

  • The name, address, email address, and telephone number of the insured;
  • The patient’s name;
  • The name and telephone number of your employer;
  • The name, address, and telephone number of the insurance company;
  • The name of the contact person at your insurance company;
  • The name, type of provider, address, and telephone number of your health care provider;
  • A description of the dispute; and
  • An “Expedited Appeal Certification by Treating Healthcare Provider” form found in the external review packet (This form is for expedited external review requests only).[8]

Supporting documents. You should include the following documents with your request:

  • A signed medical records release form (included in the external review request packet);
  • A copy of your insurance card or other evidence of insurance coverage;
  • A copy of your denial letter;
  • A copy of your certificate of coverage or insurance policy benefit booklet; and
  • Any medical records, statements from your health care provider, and any additional or new information and documentation you’d like the external review organization to review.[9]

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

Independent External Review
West Virginia Offices of the Insurance Commissioner
P.O. Box 50540
Charleston, WV 25305-0540[10]

How to submit an expedited external review request. If you are requesting an expedited external review, you should call (304) 558-3386 to ask for instructions on the quickest way to submit your request.[11]