During an impartial review (also known as an external review), an independent third party reviews your insurer’s decision.[4] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. You are entitled to request an impartial review if your insurer denies your internal appeal[5] You can request an expedited impartial review if one of the following circumstances applies:

  • You are hospitalized;
  • Your health care provider determines that your situation is urgent;
  • The treatment denial could seriously jeopardize your life, health, or ability to regain maximum function;
  • Your health care provider believes you would be subjected to severe pain that cannot otherwise be adequately managed without the requested treatment; or
  • The requested treatment is experimental or investigational and your health care provider certifies in writing that the treatment will be significantly less effective if not initiated promptly.[6]

You can request the expedited impartial review while you request the expedited internal appeal, if at least one of the above circumstances applies.[7] Please note that if you request an expedited appeal and the independent review entity issues a decision in favor of your insurer, you may be required to pay a $25 fee.