In most states, state external review requirements apply to all types of health plans.  In a few states, they apply only to managed care plans (such as HMOs, PPOs, or POS plans), or just to HMOs.  

You can use your state’s external review program if your health plan is an insured employer-sponsored plan or a private plan that you have purchased on your own.  Remember, state external review laws do not apply to employer-sponsored health plans that are self-funded, so if you are in a self-funded plan, you cannot use your state’s external review procedure.  At this time, your only recourse is to sue in court.  State external review programs also do not apply to Medicare and Medicaid beneficiaries.  If you are a Medicare beneficiary, you must follow the Medicare review process described in your Medicare Handbook.  If you are a Medicaid beneficiary, you can ask your state or local Medicaid office about their appeal procedures.

In most states, you can give someone else written authorization to appeal for you. In many states, your provider may appeal on your behalf with your written authorization.