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Understanding the Health Coverage and External Review Appeals Processes

The Ohio Department of Insurance has created this on-line toolkit to help consumers and medical providers understand the process by which they can appeal a health coverage claim denial made by their insurer after the appeals process with the insurer has been exhausted. The toolkit contains a helpful flowchart, articles, and answers to frequently asked questions. Those with questions about appealing their insurer's health coverage decisions can call the department's consumer hotline at 1-800-686-1526 or file a complaint to start an appeal.


Appeal Flowchart:



For more information about these processes, annual external review outcome summaries, and independent external review information for insurers and IROs, click here.

Ohio Department of Insurance
50 W. Town Street, Third Floor - Suite 300
Columbus, Ohio  43215
Mike DeWine, Governor | Jillian Froment, Director
General Info: 614-644-2658 | Consumer Hotline: 800-686-1526
Fraud Hotline: 800-686-1527 | Medicare Hotline: 800-686-1578
Consumer Affairs