Alaska external review for health insurance denials

What external review covers

External review applies to adverse benefit determinations involving medical judgment — denials based on medical necessity, appropriateness, level of care, effectiveness of a covered benefit, or whether a treatment is experimental or investigational. It also covers rescissions of coverage. It does not apply when the denial is based on an explicit benefit exclusion in your plan document.

For an expedited request (when the standard timeframe would seriously jeopardize life, health, or ability to regain maximum function), the reviewer must decide as soon as possible and no later than 72 hours.

How to file in Alaska

1. Exhaust the insurer's internal appeals process. Keep the final adverse benefit determination letter — you'll need it.
2. Open the Alaska external review page at https://www.commerce.alaska.gov/web/ins/Consumers.aspx and use the request form posted there.
3. Submit the final denial letter, your provider's medical necessity letter, supporting medical records, and any relevant guideline or peer-reviewed citations. The state-assigned IRO will review the full record.
4. The standard decision is typically issued within 45 days. The insurer is bound by the decision if the IRO reverses the denial.

Alaska notes

Alaska runs its own external review program through the Division of Insurance. Independent Review Organizations are assigned from the state's certified IRO list.

Related

• Pillar: How to appeal a health insurance denial
• Independent Medical Review by state — overview
• 2024 denial & overturn benchmark

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