During an external review, an independent third party reviews your insurer’s decision.[8] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Under New York law, you are entitled to request an external review if your insurer denies your coverage after an internal appeal.

You can also request an expedited external review if one of the following circumstances applies:

  • The denial concerns an admission, availability of care, continued stay, or health care service for which you received emergency services and have not yet been discharged from the hospital;
  • Waiting 30 days for the requested treatment would seriously jeopardize your life, health, or ability to regain function; or
  • If a delay in treatment would pose an imminent threat to your health.[9]