Common use of Expedited External Review Clause in Contracts

Expedited External Review. If you have a medical condition where the timeframe for completion of (a) an expedited internal review of an appeal involving an Adverse Determina­ tion; (b) a Final Adverse Determination; or, (c) a standard external review as described above, would seriously jeopardize your life or health or your abil­ ity to regain maximum function, then you or your authorized representative may file a request for an expedited external review by an IRO not associated with the Plan. In addition, if a Final Adverse Determination concerns an ad­ mission, availability of care, continued stay or health care service for which you received emergency services, but have not been discharged from a facil­ ity, then you or your authorized representative may request an expedited external review. You or your authorized representative may file the request immediately after a receipt of notice of a Final Adverse Determination of if the Plan fails to provide a decision on a request for an expedited internal xx­ xxxx within 48 hours. You may also request an expedited external review if a Final Adverse De­ termination concerns a denial of coverage based on the determination that the treatment or service in question is considered experimental or investiga­ tional and your health care provider certifies in writing that the treatment or service would be significantly less effective if not started promptly. Expedited external review will not be provided for retrospective adverse or final adverse determinations. Your request for an expedited independent external review may be submit­ xxx to the Director either orally (by calling 877‐850‐4740) or in writing as set forth above for requests for standard external review.

Expedited External Review. If you have a medical condition where the timeframe for completion of (a) an expedited internal review of an appeal involving an Adverse Determina­ tion; (b) a Final Adverse Determination; or, (c) a standard external review as described above, would seriously jeopardize your life or health or your abil­ ity to regain maximum function, then you or your authorized representative may file a request for an expedited external review by an IRO not associated with the Plan. In addition, if a Final Adverse Determination concerns an ad­ mission, availability of care, continued stay or health care service for which you received emergency servicesEmergency Services, but have not been discharged from a facil­ ityfa­ cility, then you or your authorized representative may request an expedited external review. You or your authorized representative may file the request immediately after a receipt of notice of a Final Adverse Determination of if the Plan fails to provide a decision on a request for an expedited internal xx­ xxxx within 48 hours. You may also request an expedited external review if a Final Adverse De­ termination concerns a denial of coverage based on the determination that the treatment or service in question is considered experimental or investiga­ tional and your health care provider certifies in writing that the treatment or service would be significantly less effective if not started promptly. Expedited external review will not be provided for retrospective adverse or final adverse determinations. Your request for an expedited independent external review may be submit­ xxx to the Director IDOI either orally (by orally(by calling 877‐850‐4740the phone number) or in writing as set forth above for requests for standard external review.

Expedited External Review. If you have a medical condition where the timeframe for completion of (a) an expedited internal review of an appeal involving an Adverse Determina­ Determina- tion; (b) a Final Adverse Determination; or, (c) a standard external review as described above, would seriously jeopardize your life or health or your abil­ abil- ity to regain maximum function, then you or your authorized representative may file a request for an expedited external review by an IRO not associated with the Plan. In addition, if a Final Adverse Determination concerns an ad­ ad- mission, availability of care, continued stay or health care service for which GB‐16 HCSC 92 you received emergency services, but have not been discharged from a facil­ facil- ity, then you or your authorized representative may request an expedited external review. You or your authorized representative may file the request immediately after a receipt of notice of a Final Adverse Determination of if the Plan fails to provide a decision on a request for an expedited internal xx­ xxxx ap- peal within 48 hours. You may also request an expedited external review if a Final Adverse De­ De- termination concerns a denial of coverage based on the determination that the treatment or service in question is considered experimental or investiga­ investiga- tional and your health care provider certifies in writing that the treatment or service would be significantly less effective if not started promptly. Expedited external review will not be provided for retrospective adverse or final adverse determinations. Your request for an expedited independent external review may be submit­ submit- xxx to the Director either orally (by calling 877‐850‐4740) or in writing as set forth above for requests for standard external review.

Expedited External Review. If you have a medical condition where the timeframe for completion of (a) an expedited internal review of an appeal involving an Adverse Determina­ tion; (b) a Final Adverse Determination; or, (c) a standard external review as described above, would seriously jeopardize your life or health or your abil­ ity to regain maximum function, then you or your authorized representative may file a request for an expedited external review by an IRO not associated with the Plan. In addition, if a Final Adverse Determination concerns an ad­ mission, availability of care, continued stay or health care service for which GB‐16 HCSC 90 you received emergency services, but have not been discharged from a facil­ ity, then you or your authorized representative may request an expedited external review. You or your authorized representative may file the request immediately after a receipt of notice of a Final Adverse Determination of if the Plan fails to provide a decision on a request for an expedited internal xx­ xxxx within 48 hours. You may also request an expedited external review if a Final Adverse De­ termination concerns a denial of coverage based on the determination that the treatment or service in question is considered experimental or investiga­ tional and your health care provider certifies in writing that the treatment or service would be significantly less effective if not started promptly. Expedited external review will not be provided for retrospective adverse or final adverse determinations. Your request for an expedited independent external review may be submit­ xxx to the Director either orally (by calling 877‐850‐4740) or in writing as set forth above for requests for standard external review.

Expedited External Review. If you have a medical condition where the timeframe for completion of (a) an expedited internal review of an appeal involving an Adverse Determina­ Determina- tion; (b) a Final Adverse Determination; or, (c) a standard external review as described above, would seriously jeopardize your life or health or your abil­ abil- ity to regain maximum function, then you or your authorized representative may file a request for an expedited external review by an IRO not associated with the Plan. In addition, if a Final Adverse Determination concerns an ad­ ad- mission, availability of care, continued stay or health care service for which you received emergency services, but have not been discharged from a facil­ facil- ity, then you or your authorized representative may request an expedited external review. You or your authorized representative may file the request immediately after a receipt of notice of a Final Adverse Determination of if the Plan fails to provide a decision on a request for an expedited internal xx­ xxxx ap- peal within 48 hours. You may also request an expedited external review if a Final Adverse De­ De- termination concerns a denial of coverage based on the determination that the treatment or service in question is considered experimental or investiga­ investiga- tional and your health care provider certifies in writing that the treatment or service would be significantly less effective if not started promptly. Expedited external review will not be provided for retrospective adverse or final adverse determinations. Your request for an expedited independent external review may be submit­ submit- xxx to the Director either orally (by calling 877‐850‐4740) or in writing as set forth above for requests for standard external review.

Expedited External Review. If you have a medical condition where the timeframe for completion of (a) an expedited internal review of an appeal involving an Adverse Determina­ tionDetermination; (b) a Final Adverse Determination; or, (c) a standard external review as described above, would seriously jeopardize your life or health or your abil­ ity ability to regain maximum function, then you or your authorized representative may file a request for an expedited external review by an IRO not associated with the Plan. In addition, if a Final Adverse Determination concerns an ad­ missionadmission, availability of care, continued stay or health care service for which you received emergency servicesEmergency Services, but have not been discharged from a facil­ ityfacility, then you or your authorized representative may request an expedited external review. You or your authorized representative may file the request immediately after a receipt of notice of a Final Adverse Determination of if the Plan fails to provide a decision on a request for an expedited internal xx­ xxxx appeal within 48 hours. You may also request an expedited external review if a Final Adverse De­ termination Determination concerns a denial of coverage based on the determination that the treatment or service in question is considered experimental or investiga­ tional investigational and your health care provider Provider certifies in writing that the treatment or service would be significantly less effective if not started promptly. Expedited external review will not be provided for retrospective adverse or final adverse determinations. Your request for an expedited independent external review may be submit­ xxx submitted to the Director IDOI either orally (by orally(by calling 877‐850‐4740the phone number) or in writing as set forth above for requests for standard external review.

Expedited External Review. If you have a medical condition where the timeframe for completion of (a) an expedited internal review of an appeal involving an Adverse Determina­ tion; (b) a Final Adverse Determination; or, (c) a standard external review as described above, would seriously jeopardize your life or health or your abil­ ity to regain maximum function, then you or your authorized representative may file a request for an expedited external review by an IRO not associated with the Plan. In addition, if a Final Adverse Determination concerns an ad­ mission, availability of care, continued stay or health care service for which GB‐16 HCSC 91 you received emergency services, but have not been discharged from a facil­ ity, then you or your authorized representative may request an expedited external review. You or your authorized representative may file the request immediately after a receipt of notice of a Final Adverse Determination of if the Plan fails to provide a decision on a request for an expedited internal xx­ xxxx within 48 hours. You may also request an expedited external review if a Final Adverse De­ termination concerns a denial of coverage based on the determination that the treatment or service in question is considered experimental or investiga­ tional and your health care provider certifies in writing that the treatment or service would be significantly less effective if not started promptly. Expedited external review will not be provided for retrospective adverse or final adverse determinations. Your request for an expedited independent external review may be submit­ xxx to the Director either orally (by calling 877‐850‐4740) or in writing as set forth above for requests for standard external review.