Step 2
If the plan says no again, take it outside the plan
This is where someone outside the insurer looks at the decision. Move quickly, send the full packet, and say plainly if waiting could harm you.
The packet still matters
Independent review helps, but the reviewer still only sees what you send.
Standard or expedited?
Standard external review is usually decided within about 45 days.
- Check whether external review applies. It often does when the denial turns on medical judgment, experimental or investigational treatment, or rescission.
- File by the deadline in the notice. Federal standards often allow filing within 4 months after a final internal adverse decision.
- Ask for expedited external review if delay could seriously jeopardize health or function.
- Send the full packet: denial notices, appeal letters, plan terms, medical records, clinician letters, and related reports.
If waiting could harm you
"I am requesting expedited external review because waiting may seriously jeopardize my health."
For that claim, the external review result is generally binding on the insurer.