External review

What does External review mean on a medical bill?

External review is the step after your plan's internal appeal runs out: an independent reviewer outside the plan looks at the denial, and the plan has to abide by the outcome. It generally applies to denials about coverage and medical necessity rather than to clerical problems. Which process you use depends on what kind of plan you have, since some run through the state and others through a federal process, and each has its own filing window. Urgent situations usually have a faster track.

What should I watch out for with External review?

• Ask your plan which external review process covers your type of plan and how to file
• Finish the internal appeal first, since it is normally required before this step opens
• Ask whether an expedited review applies when waiting would delay care you need now