External Review Rights: When Your Insurance Company Still Says No

Your insurance company denied your initial request. You filed an internal appeal. They denied that too. You are not out of options. Every state guarantees you the right to external review by independent medical experts who are not employed by your insurance company and do not have a financial interest in the outcome.

External review is one of the most underutilized patient rights in health insurance. Many people do not know it exists, and insurance companies are not required to promote it actively. But external review decisions are binding on your insurance plan, and the review is conducted by physicians in your medical specialty who evaluate whether the denial was medically appropriate.

Understanding when external review applies, how to request it, and what to expect can provide you with a powerful tool when internal appeals fail.

Ellen can help you determine if your case qualifies for external review and assist with the application process. Start here →