You should submit your request for an external review to either your health insurer or the Utah Department of Insurance (“Department”) within 180 days of your insurer’s last denial letter.[5] You can find a copy of the Health Benefit Plan Independent Review Process request form here.

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

  • The name of the person requesting the review;
  • The name, address, telephone number, and email address of the insured;
  • The name of the insurance company;
  • Insurance identification number and type of coverage;
  • The name and telephone number of your employer;
  • Reason for denial; and
  • A description of the service or treatment in dispute; and
  • “Certification of Treating Health Care Provider for Expedited Consideration of a Patient’s Independent Review” form on page 5 of the request packet (this form is for expedited external review requests only).[6]

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

  • A signed medical records release form (included with external review request packet);
  • A copy of your insurance card or other evidence of coverage;
  • A copy of the final decision letter from your health insurer; and
  • Any additional or new information or documentation not included with your request for an internal appeal.

Submitting a standard external review. If you are requesting a standard external review, you should submit your request by fax to (801) 538-3829, by email to [email protected], or by mail to the following address:

Health Benefit Plan Independent Review Process
Utah Insurance Department
Suite 3110, State Office Building
Salt Lake City, UT 84114[7]