You should submit your request for an external review to your health insurer within 120 days from when your insurer sent you the final decision.[8] Your health insurer must provide you with information regarding how to request an external review with your denial letter. You can use the insurance company form or the Wyoming Insurance Department form, which can be found here.[9]

Upon receipt of your request, your health insurer will forward your request to an independent review organization for review and notify the Insurance Department.[10]

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

  • The name, address, and telephone number of the patient;
  • The name, address, and telephone number of the insurance company;
  • Subscriber or member number and insurance claim or reference number;
  • The name and address of your treating health care provider and the name and telephone number of the contact person at your provider’s office;
  • Your medical record number;
  • Brief description of decision in dispute; and
  • The health care provider certification in the external review packet (This form is only required for expedited external reviews).[11]

Filing fee. You must submit a $15 filing fee by check or money order made payable to the Wyoming State Treasurer with your request. The fee may be waived for financial hardship.[12] If you believe you have a financial hardship, complete the “Certification of Qualification for Fee Waiver” in the external review request form.[13] If you complete that section, do not submit the filing fee.[14]

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

  • A copy of the denial letter from your health insurer;
  • A copy of your insurance card or other evidence showing coverage; and
  • Any new information and documentation that you had not included with your prior request for an internal appeal.