Independent Review

Your policy, certificate, or plan document will contain an explanation of the rights you have if an adverse benefit determination happens or you can ask your health insurance carrier.

After receiving notification of an adverse benefit determination, you must first request an internal appeal or review by the health insurance carrier.

If the health insurance carrier upholds the initial decision, you may then submit a request for an independent review.

The independent review process is administered by either the health insurance carrier or the Utah Insurance Department depending upon the type of health insurance. Contact your health insurance carrier to learn who administers the independent review process for your health insurance coverage.

If the adverse benefit determination involves a medical condition that would jeopardize your life or health, an expedited review is available.

You will need to provide information in addition to the Independent Review Request Form.

Your physician must complete the Certification of Treating Health Care Provider for Expedited Consideration of a Patient’s Independent Review page of the request form and you must submit it along with the Independent Review Request Form.

You will need to provide information in addition to the Independent Review Request Form.

Your physician must complete the Physician Certification for Experimental/Investigational Denials page of the request form and you must submit it along with the Independent Review Request Form.

The independent review organization must complete and submit the Independent Review Organization Application, along with additional documentation listed on the Checklist page of the application. Submit the application, documentation, and fee to:

Utah Insurance Department
4315 S. 2700 W., Suite 2300
Taylorsville, UT 84129.