You should submit your request for external review to the Idaho Department of Insurance (“Department”) within four months of the date on the final determination letter from your insurer.[6] You can find a copy of the external review request form here.
Information. You should include the following information with your request:
- The name, address, email address, and telephone number of the person filing the complaint (“Complainant”);
- The name of the insured individual, if different from the Complainant;
- The name, address, and telephone number of the insurance company;
- Policy identification number and claim number;
- The insured individual’s employer name and telephone number;
- The name, address, and telephone number of the patient’s health care provider;
- The name of the contact person at the health care provider’s office; and
- The reason for and details of the denial of coverage.
Supporting documents. You should include the following documents with your request:
- A signed medical release form (available here);
- A photocopy of your insurance ID card or other evidence showing you are insured with the health carrier named in your request;
- A copy of the final determination letter from your health carrier;
- A copy of your certificate of coverage or policy benefit booklet, which lists the benefits under your health plan;
- A signed “Certification by Treating Health Care Provider” form available in this packet (this form is for expedited external reviews only.[7]
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:
Idaho Department of Insurance
Attn: External Review
700 W. State Street, 3rd Floor
P.O. Box 83720
Boise, ID 83720-0043[8]
How to submit an expedited external review request. If you are requesting an expedited external review, you should contact the Department for instructions on how to submit required forms.[9] You can reach the Department at (208) 334-4250 or (800) 721-3272.