If your insurer still denies you coverage after you filed an internal grievance, you can request an external grievance review of your insurer’s decision. If your situation is urgent, you can request an expedited external grievance review.^[5] During an external grievance review, an independent third party reviews your insurer’s decision.^[6]

You should file your request for a standard or an expedited external grievance review with your health insurer within 120 days of the most recent determination letter.^[7] Your insurer must provide you with information on how to submit your request.^[8] Be sure to carefully read your insurance policy and any documentation you received with your determination letter to ensure that you follow your insurer’s instructions closely.^[9]

Once your insurer receives your request, it will submit your materials to an independent review organization. An independent reviewer will conduct an investigation and render a decision.^[10]