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External Review

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Updated January 28, 2009

Definition: External review is part of the health insurance claims denial process. It typically occurs when an independent third party reviews your claim to determine whether the insurer is obligated to pay. External review is one of several steps that comprise the appeal and review process. It is performed after the appellant has exhausted the insurance company's internal review process without success.

Most, but not all, states sponsor an external review program. A fee of $25 to 50 may be required in some states. For more information, see the FAQ on How to Resolve a Claims Dispute.

Also Known As: Third-party review

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