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 Montana law, you are entitled to request an external review if your insurer has:

  • Denied your internal appeal because it determined that the service or treatment was experimental, investigational, or not medically necessary; or
  • Rescinded your policy.[4]

You can request an expedited external review if you need urgent medical care, as determined by your health care provider.[5] If your case is urgent, you must first request an expedited internal review, as discussed above. If your health insurer decides to deny your internal appeal, it must notify you immediately and send your case directly to an independent review organization for review.[6]