Once an independent review organization receives notice that it will conduct your appeal, it will select one or more clinical peers to conduct the standard or expedited review.[14] A clinical peer is a licensed physician or other health care professional in the same or similar specialty that typically manages the medical condition or treatment under review.[15] The external review process should take no more than 45 days from the date the independent review organization receives your request.[16] If you request an expedited external review, the process should take no longer than 72 hours after your request is received by the health insurer.[17]

If your claim involves an experimental or investigational treatment, the external review organization must provide written notice of its decision within 20 days of receiving the clinical peer’s opinion in a standard external review and within 48 hours in an expedited external review.[18]