Common use of The External Appeal Process Clause in Contracts

The External Appeal Process. A. If, through Fidelis’ internal appeal process, you have received a final adverse determination upholding a denial of coverage on the basis that the service is not medically necessary or is an experimental or investigational treatment, you have four (4) months from receipt of such notice to file a written request for an external appeal. If you and Fidelis have agreed in writing to waive any internal appeal, you have forty-five (45) days from Fidelis will provide an external appeal application with the final adverse determination issued through Fidelis’ internal appeal process or its written waiver of an internal appeal.