APPEALS:

You have 180 days from the date of claim denial to submit an appeal to your insurance company. If you have any questions about your legal right to an appeal with your insurance company, please contact Consumer Services.

If you do appeal to your insurance company, New Hampshire law provides that your insurance company must make a determination on your appeal within the following time frames:

Urgent care claim appeals must be resolved as expeditiously as your medical condition requires, but in no event more than 72 hours. An urgent care claim is a claim involving a matter that would seriously jeopardize the insured’s life or health, or would jeopardize an insured’s ability to regain maximum function, or a claim concerning admission, availability of care, or the continued stay or health care services for an insured who has received emergency services, but who has not been discharged from a facility.

Non-urgent pre-service claim appeals must be resolved within a reasonable time appropriate to your medical circumstances, but in no event more than a total of 30 days (15 days for each level).

Post-service claim appeals must be resolved within a reasonable time appropriate to your medical circumstances, but in no event more than a total of 30 days for each level offered.

EXTERNAL APPEALS:

Effective September 3, 2000, the State of New Hampshire enacted a law which gives Consumers the right to an independent appeal process after they have exhausted their managed care insurance carrier’s appeal process, or if their insurance carrier fails to make a decision within the time frames noted above. This process is coordinated by the New Hampshire Insurance Department. Please contact our office if you have any questions or to file an application for an external appeal.

• Managed Care Consumer Guide to External Review
• Request for Independent External Appeal of a Health Care Decision