What is independent medical review?
In Kansas, independent medical review (IMR) is the state's form of external review. After you go through your insurer's internal appeals (with limited exceptions), the Kansas Department of Insurance (KID)can assign an independent review organization to decide whether the plan's denial was correct.
The program is governed by K.S.A. 40-22a13 through 40-22a16 (external review statutes). IMR commonly applies when care was denied as not medically necessary or as experimental/investigational.
General overview: Appeals roadmap. Start with Kansas internal appeals.
Who can use KID review?
IMR through KID generally applies to:
- Health insurance plans regulated under Kansas utilization review law (many fully insured individual and group plans)
- Denials based on medical necessity, appropriateness, or experimental/investigational treatment
KID materials state IMR usually does not apply to:
- Medicare, Medicaid, and federal employee plans
- Workers' compensation
- Self-funded ERISA employer plans
- Certain limited supplemental policies listed in K.S.A. 40-22a14(a)
Deadlines & exhaustion
Exhaust internal appeals first
You must usually complete the plan's internal appeal process (K.S.A. 40-22a14(d)), unless:
- You have an emergency medical condition and qualify for expedited IMR
- You waived the second internal level in writing (K.S.A. 40-22a09a(b))
- You have not received a final decision within 60 days of seeking internal review (unless you agreed to a delay)
120-day filing window
Request IMR in writing to the Insurance Commissioner within 120 days of receiving the adverse decision (K.S.A. 40-22a14(e)). You, your treating provider (with your authorization), or a legal representative may file.
How to file with KID
- Complete the insurer's internal appeals and keep the final adverse decision letter.
- Gather a summary letter, medical records, and supporting letters from your doctor(s).
- Submit a written IMR request to KID with the department's Independent Medical Review request form and a signed medical release (see KID publications or call for the current form).
- Include all documents you want considered. KID will determine whether your case qualifies—often within about 10 business days after receiving necessary information (K.S.A. 40-22a15).
Start at insurance.kansas.gov (search for Independent Medical Review) or call 785-296-3071 / 800-432-2484. KID publications include an IMR shopper's guide: KID publications.
There is no consumer fee for the state IMR process; the carrier pays the review organization.
How long it takes
- KID eligibility review: often within 10 business days after KID has needed documents
- Standard IMR: the review organization generally issues a written decision within 30 business days (K.S.A. 40-22a15(c))
- Expedited IMR (emergency): often within 72 hours or as fast as your condition requires
After assignment, you may send additional records directly to the review organization as KID instructs.
Is the decision binding?
For qualifying cases, the independent review organization's decision is generally binding on the health carrier regarding whether the denied service was medically necessary or covered under the contract terms. The standard of review depends on whether the dispute is medical necessity or experimental treatment (K.S.A. 40-22a15(c)).
IMR does not change what your policy covers in general—it addresses whether the plan applied the contract correctly to your situation.
If the carrier does not comply after a favorable IMR, see Regulator complaints and contact KID.
Medicaid & Medicare
- KanCare (Medicaid): State fair hearings (OAH)
- Medicare: Medicare basics