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Why does external review only apply to claims that are denied as not being medically necessary or as being experimental/investigational?

April 26, 2017Denied experimental external investigational medically necessary review

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Why does external review only apply to claims that are denied as not being medically necessary or as being experimental/investigational?

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A. Because other terms in your insurance policy are agreed upon by you or your employer when you sign up for the coverage. Doctors can differ, though, on what is experimental/investigational or medically necessary.