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.