The Affordable Care Act, the health care reform law passed in 2010, requires many health plans to meet basic standards regarding internal appeals and external review processes. An internal appeal is when you ask your insurance company to determine if its first decision to deny coverage was a correct one. An external review happens if your insurance company determines that its decision to deny coverage was correct and you believe that decision was in error.
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Appeal Process podcast
Julia Kohutiak, RN, LNC