Your health insurer should have provided you with instructions on how to request an external review with your final adverse determination letter.[7] You should follow those instructions closely. Be sure to submit your request for an external review to your insurer within four months from receiving the final decision letter.[8] You should include any new information and documentation that you did not include when you filed your grievance.

For expedited external review requests, you should submit your request to your health insurer and the independent review organization simultaneously.[9] Your health insurer is required to provide you with information on how to file this request.[10]

Once your request is received, your insurer will send the request and all relevant medical records and documentation to an independent review organization.[11]