During an external review, an independent third party reviews your insurer’s decision.[5] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Under Pennsylvania law, you are entitled to request an external review if your insurer denies your internal appeal.

You can also request an expedited external review if:

  • Your medical situation is urgent and waiting would jeopardize your life or ability to function; or
  • Your health insurer has denied covered for an admission or continued stay at a health care facility where you have not been discharged.[6]

 You can request an expedited external review at the same time that you request an expedited internal appeal.[7]