During an external review, an independent third party reviews your insurer’s decision.[3] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Under West Virginia law, you are entitled to request an external review if your insurer:

  • Denies your internal appeal; or
  • Does not provide you with a decision on your internal appeal within the required timeframe.[4]

You can also request an expedited external review if your life or health would be jeopardized by waiting 30 to 60 days.[5] You may request an expedited external review simultaneously with an internal appeal.[6]