North Dakota Appeal and External Review Information

Internal Appeal

You can appeal any coverage or claim determination made by us to deny, reduce, or terminate the provision or payment for health care services under your plan. A review must be requested in writing within 180 days following your receipt of the notice that the claim was denied or reduced.

For appeals:

Assurant Health Appeals
P.O. Box 624
Milwaukee, WI 53201-0624

External Appeal

When we have made an adverse benefit determination, final internal adverse determination or rescission based on a judgment as to medical necessity, appropriateness, health care setting, level of care, or effectiveness of the health care service, you have the right to have our decision reviewed by an independent review organization external to us. You can request this external review by contacting us or The North Dakota Insurance Department at:

North Dakota Insurance Department
600 E. Boulevard Ave.
Bismarck, ND 58505-0320
Phone 701-328-2440
Toll free 800-247-0560
Fax 701-328-4880

A request for an external independent review must be submitted within 4 months from the date you received notice of the adverse determination final internal adverse determination or rescission through our internal appeal process.

Except when a covered person's life or health would be seriously jeopardized, you must first exhaust our internal appeal process before we will grant your request for an external independent review.

You have the right to review your records, to present evidence and testimony as part of the appeals process. Your coverage will continue pending the outcome of the appeals process.

You may be required to pay up to $25 if the external appeal is upheld.