Independent Review Process Overturns Over 100 Health Insurance Denials in Pennsylvania

The Pennsylvania Insurance Department’s (PID) Independent external review established by Act 146 of 2022 allowed PID to oversee the process of reviewing eligibility determinations. After customers complete an internal appeal process through their insurer for denied services, they can submit a review request online to PID at no cost detailing why their health plan should cover a service, treatment, or benefit. Once the request for external review is received by PID and processed, consumers will know within five business days if their denial is eligible for review. More than 100 Pennsylvanians successfully appealed denied services in the first six months of the launch of the process. Consumers with questions about this process should go to PID’s Consumer Services Bureau at pa.gov/reviewmyclaim or by calling 1-877-881-6388.