During an external review, an independent third party reviews your insurer’s decision.[12] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Under Tennessee law, you are entitled to request an external review in the following circumstances:

  • Your insurer denies your internal appeal;[13]
  • Your insurer did not send you a decision on your internal appeal within the required deadlines.[14]

You can also request an expedited external review if your situation is urgent and waiting would jeopardize your life or ability to function.[15]  If your situation is urgent, you can request an expedited external review simultaneously with your request for a first level appeal.[16]