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.
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.
Q: What is Form LHL009?
A: Form LHL009 is a Request for a Review by an Independent Review Organization (IRO) in Texas.
Q: What is an Independent Review Organization (IRO)?
A: An Independent Review Organization (IRO) is an organization that reviews medical decisions to determine if they were appropriate.
Q: Why would someone need to submit Form LHL009?
A: Someone would need to submit Form LHL009 to request a review of a medical decision made by their insurance company.
Q: Who can submit Form LHL009?
A: The person who is affected by the medical decision or their authorized representative can submit Form LHL009.
Q: What information is required on Form LHL009?
A: Form LHL009 requires information such as contact details, insurance information, and details about the medical decision being reviewed.
Q: What happens after Form LHL009 is submitted?
A: After Form LHL009 is submitted, the Independent Review Organization (IRO) will review the medical decision and provide a decision within a certain timeframe.
Q: Is there a fee to submit Form LHL009?
A: No, there is no fee to submit Form LHL009.
Q: Can Form LHL009 be submitted electronically?
A: Yes, Form LHL009 can be submitted electronically if the option is available.
Q: What can someone do if they disagree with the decision made by the Independent Review Organization (IRO)?
A: If someone disagrees with the decision made by the Independent Review Organization (IRO), they may have additional options for appeal, such as filing a complaint with the Texas Department of Insurance.
Form Details:
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.