Request expedited external review
Ask for a fast independent review, decided within 72 hours, when waiting could seriously harm your health.
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- A template, not legal advice
This one is for a specific kind of coverage
It is written for the coverage tagged above. If you have a different kind (for example Medicare or Medicaid instead of a job-based or individual plan), it may cite the wrong rules. Check what kind of coverage you have and use the letter written for it.
When to use this, and what it is not
When to use this. When your doctor says waiting for a standard review could seriously jeopardize your life, your health or your ability to regain maximum function. You can ask at the same time as a fast internal appeal. You can also ask after a final denial about an admission, availability of care, a continued stay, or emergency services when you have not yet been discharged. Ask your doctor to state the urgency in writing. This right does not apply to grandfathered plans (except for surprise-billing denials), short-term plans or fixed indemnity plans. Your denial notice should say whether external review is offered.
This is a template, not legal advice. Read it, change anything that is not true for you, and send it only when you are satisfied. Your notice and your plan document control.
Fill in the letter
Your letter
[Your name] [Your address]
13 November 2026
[Name and address for external review requests, from your final denial letter or your state regulator]
Re: Request expedited external review Plan: [Name of the health plan] Member ID: [Member ID] Claim or reference number: [Claim or reference number]
To whom it may concern:
I am asking for expedited (fast) external review of my plan's denial of [The care or drug that was denied], claim number [Claim or reference number]. My plan, [Name of the health plan], denied it on [Date on the denial notice].
I ask for this review on the fast track. Why this is urgent, and what could happen if I wait: [What could happen if you wait]
Please do the following today: 1. Treat this as an urgent request and send it to an independent review organization immediately. 2. Send the reviewer my full claim file, including the clinical criteria the plan used. 3. Tell me by phone at [A phone number where you can be reached today] that you received this request, and confirm it in writing.
I understand that an expedited external review decision is due as fast as my medical situation requires and no later than 72 hours. If the first notice of the decision is not in writing, I ask for written confirmation within 48 hours. I ask that the decision be sent to me and to my doctor by phone, fax or another fast method.
Enclosures: 1. Copy of the denial notice 2. Letter from your doctor stating why the matter is urgent 3. Medical records that support the request
Sincerely, [Your name]
Before you send it
Send it by the fastest method your denial notice allows, such as fax or the online portal, and then call to confirm it arrived. If your plan uses the federal external review process run by the United States Department of Health and Human Services, the information line is 1-888-866-6205. Otherwise use the contact on your denial notice. Write down the name of the person you speak with, the date, the time and a reference number.
What to enclose
- Copy of the denial notice
- Letter from your doctor stating why the matter is urgent
- Medical records that support the request
What happens next
- Call the plan and the reviewer's office the same day to confirm they received your request. Write down names, times and reference numbers.
- An expedited decision is due as fast as your medical situation requires and no later than 72 hours. That is a ceiling, not a target.
- If you are told you do not qualify for the fast route, ask for that answer in writing and ask that your request go forward as a standard external review.
- If the reviewer reverses the denial, the plan must provide coverage or payment immediately and without delay, even if it plans to ask a court to review the decision.
- If you cannot wait, call your doctor or emergency services first. This letter does not replace medical care.
- If you are writing for someone else, tick "I am writing for someone else". The office you are writing to may require its own authorization form. See the letter "Name someone to act for you".