external review process for appeals

Hi,        i was wondering if anyone has had to go through the external review process after being denied on and appeal.  How long does it take and what does it entail. thank you, Cheryl

Cheryl: The time that it takes to adjudicate your appeal can be dependent on the state in which you live, as most states have departments of managed health care or insurance to review appeals if the health insurance company's decision does not meet your approval.  As a general rule, these external appeal parties have 30 days to resolve your concern.  However, it can be shorter or longer than that depending on other factors. In a nutshell, the external review party generally reviews your information in the similar fashion that your health insurance companies does.  The main difference though is that the external committee is not bound by to make decisions based on how much money it would save the insurance company.  It is basically your advocate in helping determine the medical necessity of a case; thus, they tend to be less biased than the insurance company. You can check your explanation of coverage for your plan for the details on what steps you should take to submit your second-level appeal to this external committee.  If you do not have one, contact member services to have one sent to you, or check your insurance plan's Web site to see if you can download one.  There might be information on second-level appeals on the site as well.