How to Request an External Appeal. If you remain dissatisfied with our medical appeal determination, you may request an external review by an outside review agency. In accordance with §27-18.9-8, your external appeal will be reviewed by one of the external independent review organizations (IRO) approved by the Office of the Health Insurance Commissioner. The IRO is selected using a rotational method. You may also request an external appeal by an outside agency if you are dissatisfied with our appeal determination related to any of the following special circumstances as described in more detail in Section 6: • Emergency room services; • Air ambulance services; • Non-emergency covered healthcare services rendered by a non-network provider at certain network facilities. To request an external appeal related to any of the above scenarios, submit a written request to us within four (4) months of your receipt of the appeal denial letter. We will forward your request to the outside review agency within five (5) business days, unless it is an urgent appeal, and then we will send it within two
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Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement
