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You can appeal an insurance company's decision to deny a claim or a decision
to pay less than the amount billed. The Division of Financial Regulation can
explain the appeals process. Call one of our consumer advocates or file a
complaint to get help. Here is an overview.
Under external review, you may ask your insurance company for an independent (external)
review to determine whether treatment is:
Independent review organizations (IROs) are independent of the insurers. They
review medical records and other materials to decide if the insurer made the correct
decision. Do not forget that you have to finish the company’s internal appeal
process first unless you both agree to go directly to external review.
IROs must provide the division with a brief description of each decision and
an annual report summarizing outcomes.
File a complaint online or contact us:
Always verify that the company or individual you are working with has a license.
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Consumer Guide to Health Insurance Appeals
This guide will help you understand your appeal rights in the event of a denial.
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