During an external review, an independent third party reviews your insurer’s decision.[7] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Under Washington law, you are entitled to request an external review in the following circumstances:

  • If your insurer denies your coverage after an internal appeal; or
  • If your insurer does not meet the required timeframes for providing you with a decision on the internal appeal.[8]

You can also request an expedited external appeal if your medical situation is urgent and waiting would jeopardize your life, health, or ability to function and you requested an expedited internal appeal.[9]