When does external review usually happen?

External review usually comes after the insurer issues its final internal appeal determination, although urgent situations may qualify for a faster path depending on the plan and the medical urgency.

How long do I usually have to request external review?

Many external review processes allow about four months after the final internal appeal denial, but you should rely on the instructions in your final determination notice because the process can vary.

External Review for Health Insurance Denials

External review is an independent review of a health insurance denial by a third party outside the insurer. It usually comes after the insurer finishes the internal appeal process, although urgent cases can sometimes move faster, so you should use the denial and final determination notices to confirm the next step.