Whom to contact:

Iowa Insurance Division

Who can appeal:

You or your provider (with consent)

What you can appeal:

Denials for medical service claims your health plan believes are not medically necessary.

When you can appeal:

After denial for coverage has been appealed through all levels of the health plan’s internal process, you must file within 60 days of the denial.

What to send:

1. A letter detailing why you are requesting the review and providing a return address and day-time phone number for both you and your provider.
2. A photocopy of the letter denying coverage from your health plan.
3. The $25 filing fee.

What you must pay:

$25 (The fee will be refunded if the decision is in your favor, or the fee may be waived by the Commissioner).

What will happen:

The health plan will select an independent review agent from a list approved by the insurance department.

When you will get a decision:

Approximately 35 days for an uncontested review and 45 days for a contested review

In urgent situations:

If a delay would jeopardize your health, an expedited review may be requested and a decision will be delivered within 72 hours