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Idaho Gets External Review (Updated)

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Idaho will require state-regulated health insurers to offer independent external reviews of some claim denials starting Jan. 1, 2010.

As a result of the enactment of the Idaho Health Carrier External Review Act, claimants have the right to a review if a “denial is based on a finding by the plan that a service or supply is not medically necessary or is investigational,” William Deal, Idaho insurance director, writes in Bulletin Number 09-08.

The Idaho external review act applies to health maintenance organizations and health service corporations as well as health insurance companies, Deal writes.

If a claim denial is eligible for review, a request for a review “will be randomly assigned to an independent review organization that has been approved by the department to review health claims,” Deal writes.

UPDATE: An earlier version of this article said the Idaho Health Carrier External Review Act also applies to disability insurance claims. Deal wrote in the bulletin that the act applies to disability insurers as well as to health insurers. We have since learned that the language of the Idaho statute specifically excludes disability income insurance.

A copy of the bulletin is available here.

A copy of the statute is here.