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Insurance Division

External Review Results

Oregon's External Review law for health insurance denials has been in effect since July 1, 2002. Patients who have appealed a denial through their insurer's internal appeals process can request that their claim be evaluated by an independent review organization (IRO) that is separate from the insurer. The review is paid for by the insurer, and is free of charge for the patient.

External review annual summaries

External Reviews submitted January 1, 2009 through December 31, 2011

    Reviews to date total : 304

  • Standard 30-day Reviews: 292
  • Expedited 3-day Reviews: 12

    Reasons for review:

  • Questions of medical necessity: 155
  • Experimental or investigational procedures: 53
  • Requests for continuity of care: 0
  • Contract language questions ineligible for review: 36

    Outcomes of reviews:

  • Denials reversed by the IRO: 88
  • Denials upheld by the IRO: 116