Form LHL009 Request for a Review by an Independent Review Organization - Texas

Notification Icon This version of the form is not currently in use and is provided for reference only. Download this version of Form LHL009 for the current year.

Form LHL009 Request for a Review by an Independent Review Organization - Texas

What Is Form LHL009?

This is a legal form that was released by the Texas Department of Insurance - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form LHL009?A: Form LHL009 is a Request for a Review by an Independent Review Organization in Texas.

Q: What is the purpose of Form LHL009?A: The purpose of Form LHL009 is to request a review of a medical necessity denial by an Independent Review Organization.

Q: Who can use Form LHL009?A: This form can be used by individuals or their representatives who have had a medical necessity denial and want to seek a review.

Q: How do I complete Form LHL009?A: You need to provide your personal information, details about your denial, and include any supporting documentation.

Q: Is there a submission deadline for Form LHL009?A: Yes, Form LHL009 must be submitted within 30 days of receiving a notice of denial.

Q: What happens after I submit Form LHL009?A: After submitting the form, the Independent Review Organization will review your case and provide a decision.

ADVERTISEMENT

Form Details:

  • Released on September 1, 2020;
  • The latest edition provided by the Texas Department of Insurance;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form LHL009 by clicking the link below or browse more documents and templates provided by the Texas Department of Insurance.

Download Form LHL009 Request for a Review by an Independent Review Organization - Texas

4.7 of 5 (11 votes)
  • Form LHL009 Request for a Review by an Independent Review Organization - Texas

    1

  • Form LHL009 Request for a Review by an Independent Review Organization - Texas, Page 2

    2

  • Form LHL009 Request for a Review by an Independent Review Organization - Texas, Page 3

    3

  • Form LHL009 Request for a Review by an Independent Review Organization - Texas, Page 4

    4

  • Form LHL009 Request for a Review by an Independent Review Organization - Texas, Page 1
  • Form LHL009 Request for a Review by an Independent Review Organization - Texas, Page 2
  • Form LHL009 Request for a Review by an Independent Review Organization - Texas, Page 3
  • Form LHL009 Request for a Review by an Independent Review Organization - Texas, Page 4
Prev 1 2 3 4 Next
ADVERTISEMENT

Related Documents