Every state has a different procedure for handling external reviews.  You will usually receive instructions for filing an external appeal when your internal appeal is denied by your health plan.  In some states, you begin the external appeal by contacting your health plan again.  Others require that you contact your state’s department of insurance or other state agency to initiate your appeal. 

The actual review may be performed by the state agency itself or through an independent review organization hired by the state or selected by the plan.  Usually you do not have to pay for such reviews, though some states charge a nominal amount, usually $25 to $50.  Several states have provisions to waive these charges if you demonstrate that they would cause financial hardship.

Although some states schedule a hearing and allow you to speak directly with the reviewer, most do not.  In many states, it is not clear whether either you or your health plan must accept the decision made by external review.  In such cases, you may be able to appeal to the court system if you are not satisfied with the result of your external review.  You will likely need to contact a lawyer to determine what, if any, rights you may have if you are not satisfied with the results of an external review.