Common use of External Appeal Clause in Contracts

External Appeal. If you remain dissatisfied with the determination, you may request an external review by an outside review agency. There is no minimum dollar amount that a claim must be in order to file an external appeal. To request an external review you must submit your request in writing to us within four (4) months of your receipt of the determination. We will forward your request to the outside review agency within five (5) business days, or two (2) business days for an expedited external appeal. We may charge you a filing fee up to $25.00 per claim and $75.00 per claimant per plan year payable to us. We are responsible for any costs and fees from the outside review agency for the external appeal, not to exceed $75.00 per benefit year. We will refund you if the denial is reversed and will waive the fee if it imposes an undue hardship on you. For all non-emergency appeals, the external appeal agency will notify you of its determination within ten (10) business days of the agency’s receipt of the information. For all emergency external appeals, the external appeals agency will notify you of its determination no later than seventy-two (72) hours from the agency’s receipt of the appeal. The determination by the outside review agency is binding upon us. This External Appeal is voluntary. This means you may choose to participate in this level of appeal, or you may file suit in an appropriate court of law (Please see Legal Action, below).

External Appeal. If you remain dissatisfied with the determination, you may request an external review by an outside review agency. There is no minimum dollar amount that a claim must be in order to file an external appeal. To request an external review you must submit your request in writing to us within four (4) months of your receipt of the determination. determination We will forward your request to the outside review agency within five (5) business days, or two (2) business days for an expedited external appeal. We may charge you a filing fee up to $25.00 per claim and $75.00 per claimant per plan year payable to us. We are responsible for any costs and fees from the outside review agency for the external appeal, not to exceed $75.00 per benefit year. We will refund you if the denial is reversed and will waive the fee if it imposes an undue hardship on you. For all non-emergency appeals, the external appeal agency will notify you of its determination within ten (10) business days of the agency’s receipt of the information. For all emergency external appeals, the external appeals agency will notify you of its determination no later than seventy-two (72) hours from the agency’s receipt of the appeal. The determination by the outside review agency is binding upon us. This External Appeal is voluntary. This means you may choose to participate in this level of appeal, or you may file suit in an appropriate court of law (Please see Legal Action, below).