External review
Updated September 30, 2026
Definition
A review of your health plan's denial by an independent reviewer who doesn't work for your plan. Your plan must accept the reviewer's decision.
External review is a way to have someone outside your health plan look at a denial. It usually comes after your plan turns down your internal appeal. In urgent cases, you may be able to ask for it sooner.
It covers denials based on medical necessity, the level or setting of care, or a claim that care is experimental. It also covers a plan canceling your coverage back to an earlier date. You must ask in writing within 4 months of your plan's final denial notice.
A standard review is decided within 45 days, and an expedited review within 72 hours. The federal process is free, and other processes can't charge more than $25. Your plan must accept the reviewer's decision. Our guide to external review for health insurance explains when and how to ask.
Related terms
Guides that use this term
- GuideInternal appeal vs. external review: which comes whenAn external review lets an outside reviewer decide your health insurance denial. Learn when you can ask, your 4-month deadline, and how the decision works.
- Start hereHow to appeal a health insurance denialA denied claim isn't the final word. Learn how to appeal an insurance denial, from internal appeal to external review, with deadlines for each plan type.
- GuideInsurance didn't pay my medical bill: what to do nextInsurance didn't pay your medical bill? Find out why, match the denial code to the fix, and learn when to ask for a rebill and when to file an appeal.
Sources
- External review (glossary), HealthCare.gov. Accessed September 30, 2026.
- External review, HealthCare.gov. Accessed September 30, 2026.
This is general information, not legal or medical advice. Rules can depend on your plan and your state. Romi Care isn't an insurer, law firm, collection agency, or government program.