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External review: when the insurer says no again

After a final denial, an independent reviewer can decide. How to ask, the deadline, and what happens next.

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What it is

An external review is a decision by an independent reviewer, not your insurer. If the reviewer decides for you, the plan must pay.

Deadline

You must ask in writing within 4 months of the final denial.

Urgent cases

If waiting could seriously harm your health, you can ask for an expedited external review.

More guides

Sources

  1. HealthCare.gov: External review