You must file your request for an external review with the District of Columbia Office of Health Care Ombudsman and Bill of Rights within four months of the date on your insurer’s most recent decision.

Information.

You can find a copy of the external review request form here.[9] You should include the following information:

  • The name of the person requesting review;
  • The name and address of the insurance company;
  • A description of the review requested;
  • The patient’s name, date of birth, gender, address, telephone number, and email address;
  • The patient’s diagnosis and procedures performed;
  • The name, address, and telephone number of the referring physician;
  • The name, address, and telephone number of the treating facility;
  • Member identification number
  • Date of final decision; and
  • Basis for the appeal.[10]

Supporting documents.

You should also include the following supporting documents with your application:

  • A copy of all determination letters from your health insurer;
  • A signed medical records release form here; and
  • Any medical records, health care provider statements, and other information for the external review agency to consider.[11]

How to submit an external review request.

You can submit your request and supporting documents by fax to (202) 478-1397 or by mail to the following address:[12]

Government of the District of Columbia
Office of Health Care Ombudsman and Bill of Rights
One Judiciary Square
441 4th Street, NW, Suite 900S
Washington, DC 20001

Questions.

If you have questions regarding the process, you can contact the Office of Health Care Ombudsman and Bill of Rights at (977) 685-6391.