Department of Labor and Regulation

Title - Division of Insurance email the Division of Insurance

External Review — Health Insurance/Major Medical

Filing an External Review

When you have gone through all your options to appeal a denial of coverage or benefit, you may have the right to an External Review. An External Review means an organization not connected with your insurance company reviews your complaint and makes a decision.

Your insurance company is required to notify you of your options regarding the External Review process when they send notice of their final decision about your complaint.

In order to be eligible, you must file within four months of the denial. The cost is $25 and will be refunded to you if the Independent Review Organization's decision is in your favor.

The forms, along with a required information checklist (in Adobe .pdf format*), can be found below. The External Review process can take up to two months.

The Division of Insurance is in charge of the External Review process. If you have any question please contact us.

Resources Used for Filing an External Review
(most in Adobe .pdf format*)

Checklist

External Review Request Form

External Review Request Form for Use with Expedited Review Only

External Review Request Form for Use with Experimental/Investigational Denials Only

Independent Review Organizations

Contact Us

445 East Capitol Avenue
Pierre, SD 57501
Phone: 605.773.3563
Fax: 605.773.5369
email

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Division of Insurance
445 E. Capitol Avenue
Pierre, SD 57501
Tel. 605.773.3563
Fax. 605.773.5369