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

  • If your insurer denies your coverage after an internal appeal; or
  • Your insurer has not responded to your internal appeal request within the required 30 or 60 day timeframes and you have not agreed to extend or waive the time.[8]

You can also request an expedited external review if your medical situation is urgent. You can file a request for an expedited external review while you file a request for an urgent care appeal.[9]