During an external review, an independent third party reviews your insurer’s decision.[16] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Under North Carolina law, you are entitled to request an external review if your insurer denies your appeal on the basis that the services are not medically necessary, are experimental, or are cosmetic.[17]

You can also request an expedited external review in urgent situations at the same time you file a request for an expedited appeal.[18] Your situation is urgent if waiting would jeopardize your life or ability to function.