You should submit your request for external review to the New York Department of Financial Services (“Department”).[10] You must submit your request within four months from the date of the determination letter from the first level of appeal even if your health insurer offers a second level of internal appeal.[11]

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

  • The name of the applicant;
  • The name, address, telephone number, and email address of the patient;
  • The name of the insurance company;
  • The name, address, and telephone number of the patient’s healthcare provider;
  • Reason for health plan denial; and
  • Description of complaint and dates of service.[12]

Supporting documents. You should submit any new information and documentation not included with your request for an internal appeal with your request for an external review. If you are requesting an expedited review, you should also attach a Physician Attestation form, which is including in the external review request packet.[13]

Filing fee. You must pay a $25 filing fee by check or money order made payable to your health insurer, if your health insurer requires such a fee.[14] The fee can be waived if you are covered by Medicaid, Child Health Plus, Family Health Plus, or if the fee will pose a hardship. If you qualify for the wavier or your appeal is successful, your fee will be refunded to you.[15]

Submitting a standard external request. You can submit the request to the Department by fax to (800) 332-2729 or by certified or registered mail to the following address:

Department of Financial Services
P.O. Box 7209
Albany, NY 12224[16]

Submitting an expedited review. If you are requesting an expedited external review, you must contact the Department of Financial Services at (888) 990-3991.[17]