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What is an external review request?

A review of a plans decision to deny coverage for or payment of a service by an independent third-party not related to the plan. If the plan denies an appeal, an external review can be requested.

What is the federal external review program?

The HHS-Administered Federal External Review Process applies to adverse benefit determinations, including those that involve medical judgment (including, but not limited to, those based on the plans or issuers requirements for medical necessity, appropriateness, health care setting, level of care, or effectiveness

What does external review mean?

External review is a process where you may seek an independent review of a health insurance company decision to refuse to pay for or authorize a treatment or service.

How long does an external review take?

Standard external reviews are decided as soon as possible no later than 45 days after the request was received.

What is an external insurance appeal?

If an insurance company upholds its decision to deny payment, the law provides consumers with the right to appeal the decisions to an outside, independent decision-maker, regardless of the type of insurance or state an individual lives in.

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