First-level Internal Appeal Process

Once you have received a decision on your utilization review appeal, you have completed the first-level internal appeal process. If the decision is not in your favor, you are entitled to request an external review. If you and your insurer waive the firstlevel review, you are then permitted to proceed directly to an external review. (See utilization review appeal and external review.)

See Also: Dental Care; External Appeal/External Review; Fee-for-Service; Grievance;

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