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 New Hampshire law, you are entitled to request an external review if your insurer denies your appeal, and the denial was based on the insurer’s belief that the recommended treatment or service:

  • Is not medically necessary,
  • Is not appropriate for your condition, or
  • Does not meet the insurer’s requirements for health care setting or level of care or effectiveness.[4]

You can request an expedited external review if your medical situation is urgent and waiting will jeopardize your health, life, or ability to function.