During an external review, an independent third party reviews your insurer’s decision.[11] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim.

Under Massachusetts law, you are entitled to request an external review in the following circumstances:

  • Your insurer denies your coverage after an internal grievance review within the allotted timeframe;
  • There is a serious and immediate threat to your health (in this case, you should apply for an expedited external appeal).[12]

You can file a request for an expedited external review at the same time that you request an expedited internal grievance review.[13]