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Am I eligible for a review?

Under the Affordable Care Act, health insurance issuers in certain States (which have not met minimum consumer protections in their external review process) may choose either: the HHS-administered federal external review process or they may contract with accredited independent review organizations to review external appeals on their behalf.

Consumers may request an external review from the HHS-Administered Federal External Review Process if:

  • You are enrolled in a municipal, local, county, state, or other type of governmental health plan, and your health plan selected to use the HHS-Administered Federal External Review Process for external review

OR

  • You are enrolled in an individual health insurance policy that was issued in one of the states and territories listed below, and your insurer selected to use the HHS-Administered Federal External Review Process. Consumers in some group health plans may also be eligible. Your plan's notice of external review rights should say if you are eligible.

Issuers in the following states are eligible to use the HHS-Administered Federal External Review Process:

To find out if your plan or issuer has selected to use the HHS-Administered Federal External Review Process or has elected to use a privately-accredited independent review organization, please read your adverse benefit determination notice. It should explain how to request an external review.

If you cannot find this information in your adverse benefit determination, or you cannot find your adverse benefit determination, please call the member services phone number on your health plan ID card for help.



States Territories
Alabama Alaska American Samoa
Florida Georgia Guam
Louisiana Mississippi (until 1/1/2013) Northern Mariana Islands
Montana Nebraska Puerto Rico
Pennsylvania West Virginia U.S. Virgin Islands
Wisconsin
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