When are insurers required to disclose information about external review to insureds?
Information about the right to external review must be included in the insurer’s notice of a noncertification decision and notice of a decision on appeal and second-level grievance review when the decision is to uphold the original noncertification. The insurer is also required to a advise the insured of their rights to external review, and provide a general description of the external review process in the member policy, booklet, or evidence of coverage.
