Whom to contact:

Kansas Insurance Commissioner

Who can appeal:

You, your provider (with consent), or your authorized representative

What you can appeal:

Denials of coverage for services the health plan determines are not medically necessary or are experimental or investigational.

When you can appeal:

After denial for coverage has been appealed through all levels of the health plan’s internal process (except for an expedited appeal), you must file within 90 days from the adverse determination.

What to send:

A completed form, which includes a medical records release. You should also write a letter summarizing your situation and providing as much information as possible, including any medical literature that supports your case.

What you must pay:

No charge

What will happen:

1. The Insurance Commissioner reviews the case within 10 days to determine if it qualifies for review.
2. If the case is accepted, it is sent to the external review organization.
3. You and your health plan have 7 days to provide additional information.
4. The case is assigned to a physician.
5. The review organization notifies you, your health plan, and the Insurance Commissioner of the decision.

When you will get a decision:

Within 30 business days after submitting your request

In urgent situations:

An expedited review is available for an emergency medical condition; the case is immediately evaluated and sent to the review organization, you have 5 days to provide additional information, and a decision will be made within 7 business days.