During an external review, an independent third party reviews your insurer’s decision.[5] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Under South Dakota law, you are entitled to request an external review if your insurer denies your coverage after a grievance.

You can also request an expedited external appeal if:

  • Your medical situation is urgent and waiting would jeopardize your life or ability to function;
  • The initial denial of coverage is based on the health insurer’s determination that the treatment is experimental or investigational; or
  • Your physician certifies in writing that the requested service or treatment would be significantly less effective if not promptly initiated.[6]

 You can request an expedited external review while you request an expedited grievance review.[7]