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External Review Request Letter: Free Sample and Steps
How to request independent external review after a final internal denial, with a free sample paragraph.
For most ACA-governed plans, you can request external review within 4 months of receiving a final internal adverse determination. Depending on your plan, it runs through your state or a federal process. Your final denial letter should tell you where to send the request.
Free sample appeal paragraph
I request an independent external review of [plan]'s final adverse determination dated [date] denying [service]. I disagree with the determination because [reason]. Enclosed are the denial letters, my internal appeal, medical records and a letter of medical necessity.
Replace the [brackets] with your details. This is a starting point, not legal advice.
What to do
- Include your final denial letter.
- Use the form your state or the federal process provides, if any.
- Ask for expedited external review if urgent.
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Start the free checkFrequently asked questions
Does external review cost money?
Often it's free or a small fee, which varies by state and process. Check your final denial letter.
Which denials can go to external review?
Generally those involving medical judgment (such as medical necessity or experimental treatment) or rescission of coverage. Check your notice.
How do I appeal a external review request denial?
Start with the instructions and deadline on your denial letter. Gather your medical records and a letter of medical necessity, respond directly to the stated denial reason, and file an internal appeal. Keep proof of submission.
Is external review available?
For many non-grandfathered plans, independent external review may be available for denials involving medical judgment after a final internal denial, generally within 4 months. Confirm on your denial notice.
Related guides
- ACA Internal Appeal Deadlines Explained
- ACA External Review: How It Works
- Medicare Advantage Organization Determination Appeals
- How to Appeal a Medicaid Denial (Plan Appeal and State Fair Hearing)
- How to Appeal a Medicare Part D Drug Denial
- How to Appeal an Employer Health Plan Denial (ERISA Plans)
- All appeal guides
Document preparation / educational use only. This site is not a law firm, regulator, airline, insurer, or parking operator. Nothing here is legal advice. Outcomes are never guaranteed. Review every letter carefully before sending and consult a licensed professional if you need advice about your situation.