You should submit your request for an external review to the New Jersey Department of Banking and Insurance (“Department”) within four months from when your insurer sent you the most recent decision.[12]

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

  • The name, address, telephone number, email address, and date of birth of the insured individual;
  • The name of the insurance company;
  • The identification number and policy number;
  • The name, address, telephone number, and email address of the person filing the request and his or her relationship to the patient;
  • A description of the reason for the appeal; and
  • If you are requesting an expedited external review, a statement that you are requesting expedited review and the reasons why you believe expedited treatment is needed.[13]

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

  • A signed medical records release form;
  • All information submitted to the health insurer;
  • Any additional or new information you would like the external review organization to consider;
  • A copy of the initial denial letter from your health insurer; and
  • Copies of the insurer’s decisions on the internal appeals.[14]

Do not send copies of your medical records with the request. The Department will give you instructions on how to submit copies of your medical records after the external review organization accepts your request.

Submitting a standard external review. You can email your request to [email protected], or mail it to:

NJ Department of Banking and Insurance
Consumer Protection Services
Office of Managed Care
P.O. Box 329
Trenton, NJ 08625-0329[15]

(If using courier service: 20 West State St., 9th Floor)

Submitting an expedited review. For expedited requests, you can fax the request and supporting documents to (609) 633-0807.

Filing Fee. There is a $25 processing fee for applications accepted by the external review organization. The fee may be waived if you can show financial hardship.