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. Pursuant to Delaware’s Independent Healthcare Appeals Program, you are entitled to request an external review if your insurer denies you coverage or preauthorization request after you requested an internal appeal.[4]

You can skip the internal appeals process and request an expedited external review if you have a condition that poses an imminent, emergent, or serious threat or have an emergency medical condition.[5]