• Most insurance companies will offer a chance to appeal a claim denial. Contact your insurance company for additional information.
• The Iowa Insurance Division offers external review on medically necessary claims that are denied by an insurance company through all levels of appeal. If an independent review entity believes the claim should be paid, the insurance company will pay the medically necessary claim.
• The Insurance Commissioner has no authority over employer self-funded plans (where no insurance company underwrites the plan). Employer self-funded plans will be subject to some regulation by the U.S. Department of Labor.
Internal Appeals and External Review
When a disagreement occurs between insurance companies and their insured consumers (or sometimes the provider on a consumer's behalf), insurance companies usually offer an opportunity for an internal review of that denied claim. If a consumer has exhausted all internal appeal opportunities with their insurance company, a consumer may request that an external (outside of the insurance company) review entity determine if the consumer's claim should be approved. Requests for external review should be made through the Iowa Insurance Division.
Transcript of Comments at Health Insurance Cost Reduction Working Group Meeting, September 13, 2010
HIPIowa: Non-profit high risk health insurance plan (no underwriting allowed)
Hawk-I: Non-profit children's health care coverage
Senior Health Insurance Information Program (Medicare information)