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

  • Your situation is urgent;
  • If you have not received a decision within 35 days if you requested standard internal appeal or within three business days if you requested an urgent care request;[4]
  • Your insurer denies your internal appeal.

Please note that if your situation is urgent, you do not need to wait for a decision from your insurer. You can request an expedited external review at the same time that you request an expedited urgent care request from your insurer.[5]