If there was a treatment you wanted but were denied and you’re not happy with Kaiser’s decision after you exhausted your internal appeal with Kaiser, you can request an “external review” of Kaiser’s decision.
Be sure to review and follow the external review procedures described on your appeal denial.
The Affordable Care Act gives patients the choice to have a 3rd party, independent organization review adverse decisions by non-grandfathered health plans. Patients have 130 days to file their request for external review from final date of coverage denial.
Learn how to submit your external review request to the Hawaii Insurance Division here.
Some of the forms required include:
- A cover letter explaining why you’re appealing the health plan’s decision
- $15 filing fee
- Copy of the final internal determination from Kaiser
- A release of medical records form
- A conflict-of-interest disclosure
You may need to request the “release of medical records” and “conflict-of-interest disclosure” forms from Kaiser. You can see examples of the pre-filled forms that HMSA, another Hawaii insurer, provides its own members who want to file an eternal review, click here.
