Beginning July 1, 2002, many North Carolina consumers will have a new option for handling disputes when their HMO claims are denied.

That's when the state's "external review law" goes into effect. External review is an independent review done by independent medical professionals and their decision is binding on health insurers. If the external review determines that the insurer was wrong in denying coverage, the insurer must reverse its decision and pay for the requested service.

According to the North Carolina Department of Insurance (NCDOI), the law does not cover self-funded employee health plans covered under ERISA (the Employee Retirement Income Security Act), Medicare, or Medicaid, and does not cover denials for reason other than medical necessity. Any health plan member whose initial denial decision was made on or after July 1, 2002, can request an external review. However, you must exhaust all appeals procedures with your insurer before you become eligible for external review.

Standard external review cases are required to be completed within 45 days. Expedited cases for life-threatening medical conditions must be completed within four days. You can call (877) 885-0231 for more information. Request forms are also available online at the NCDOI Web site.