External Review in the United States

Concept of External Review in Health Insurance Law

In this context, the following is a definition of External Review: The review of a health plan’s determination that a requested or provided health care service or treatment is not or was not medically necessary by a person or entity with no affiliation or connection to the health plan. PPACA requires all health plans to provide an external review process that meets minimum standards.

External Review in Health Care Law

A definition of External Review is available here: The Affordable Care Act requires all health plans (except Grandfathered plans) to provide an external review appeal process.