The Independent Medical Review Program

7 The IMR process allows for exceptions to be made when there is a serious or imminent threat to your health. CIC Section 10169.3(c) states that if the “insured’s provider [your doctor/ medical professional] or the department [CDI] certifies in writing that an imminent and serious threat to the health of the insured [you] may exist, including but not limited to, serious pain, the potential loss of life, limb, or major bodily function, or the immediate and serious deterioration of the health of the insured,” the IMR organization must make its determination within three days of receiving the proper case information. Moreover, your insurance company must deliver the necessary information and documents to the IMR organization within 24 hours of approval from the CDI of your IMR request. WhentheCDI reviewsyour request foranIMR, theDepartmentmay waive the requirement that you first go through your insurance company’s appeals/grievance process when an extraordinary or compelling case exists. The Insurance Commissioner may make exceptions based on the criteria listed in CIC Section 10169.3(c) above and based on the Insurance Commissioner finding that you have acted reasonably in the dispute with your insurance company. You will not be required to pay an application or processing fee for an IMR. The cost of the IMR is paid completely by your insurance company after it has been decided that your request qualifies for an IMR by the CDI. Is there a way to process an Independent Medical Review more quickly in extraordinary circumstances? Will an Independent Medical Review be costly?