Source: https://coveragerights.org/kansas/
Timestamp: 2019-04-22 14:36:45+00:00

Document:
How do I request a second level internal appeal?
If you have a group plan and your insurer denies your claim after the first level internal appeal, you may have to request a second level internal appeal. During a second level internal appeal, you will have the right to appear in person and present your case directly to your health insurer’s representatives.
Your health insurer must notify you if it offers a second level appeal. It will provide you with instructions on how to request the appeal and the deadline for filing the request. It will also provide you with instructions on how to waive the second internal appeal if you decide you do not want to request one.
30 days if you have received the service or treatment but have been denied for reimbursement.
In what circumstances can I apply for an independent medical review?
During an independent medical review (also referred to as an external review), an independent third party reviews your insurer’s decision.
Your health care provider certifies in writing that the requested treatment would be significantly less effective if not initiated promptly.
How do I request an independent medical review?
You can submit a request for an independent medical review to the Kansas Department of Insurance (“Department”) within 120 days of receiving a final decision from your insurer.
You should contact the Department at (800) 432-2484 to request a copy of the Independent Medical Review request form.
All correspondence sent to you by your insurer.
To request an expedited independent medical review, contact the Department at (800) 432-2484 and ask for an independent medical review coordinator to help you with the process.
How long will the independent medical review process take?
Within ten business days of receiving your request for an independent medical review, the Department will determine whether your situation qualifies for review by an independent review organization. If your request is approved, the Department will forward your request to an independent review organization for further examination. A written decision will be issued to you within 30 business days. If you requested an expedited independent medical review, the process should take no longer than 72 hours after your request is received.
If you are a Kansas resident and your insurer denies your coverage after the independent medical review process, you can file a complaint with the Department.
The reason for and details of the complaint.
Once the Department receives your complaint, it will forward a copy to your insurance company for a response and send you a letter of acknowledgement. If the health insurer has violated a law or regulation, the Department will request that the insurer take corrective action.
You can contact the Department at (785) 296-7829 or (800) 432-2484. The Department is open from 8:00 a.m. to 5:00 p.m. Monday through Friday.
 Kan. Stat. Ann. § 40-22a09a (2015).
 Kan. Stat. Ann. § 40-22a14(d)(2) (2015).
 Health Insurance in Kansas, Kan. Ins. Dept. (July 1, 2015), http://www.ksinsurance.org/documents/healthlife/health/KID-Issue-Brief.pdf.
 Kan. Admin. Regs. § 40-4-42g (2016).
 Kan. Code Ann. § 40-22a14 (2015); Kan. Admin. Regs. § 40-4-42d (2016).
 Kan. Code Ann. § 40-22a13 (2015); Kan. Admin. Regs. § 40-4-42d (2016).
 Independent Medical Review, Kan. Ins. Dept., (Jan. 2015), http://www.ksinsurance.org/documents/healthlife/health/KID-Issue-Brief.pdf.
 Kan. Admin. Regs. § 40-4-42c (2016).
 Kan. Admin. Regs. § 40-4-42b (2016).
 Kan. Stat. Ann. § 40-22a15 (2015).
 Consumer Complaint Form, Kan. Ins. Dept., http://www.ksinsurance.org/documents/department/Complaint_Form.pdf (last visited Dec. 1, 2016).
 Complaint Form, Kan. Ins. Dept., http://www.ksinsurance.org/documents/department/Complaint_Form.pdf.
 How to File a Complaint, Kan. Ins. Dept., (Jan. 2015), http://www.ksinsurance.org/documents/department/publications/how-to-file-a-complaint.pdf.

References: § 40
 § 40
 § 40
 § 40
 § 40
 § 40
 § 40
 § 40
 § 40
 § 40