Evaluation by a group outside of the academic setting that can provide an impartial review of the program for purposes of accountability and improvement.

In health insurance, a consumer can request that an independent reviewing panel look at their case when an insurance company or HMO denies benefits for health care services based on issues of medical diagnosis, care or treatment, medical necessity, preexisting conditions, or services that the health insurance carrier considers to be experimental or investigational. A consumer must first exhaust the health insurance carrier's first and second level appeal and grievance process or meet the criteria for an expedited review. Return to of page.

A review of a denied claim from an outside agency other than your insurance provider. To find out if your insurance provider offers an external review or provides contact information for the agency reviewing the claim, view the “Exclusions” section of your insurance policy.

States with an external review process provide the opportunity for consumers and their providers to challenge a health plan's denial of medical coverage. An independent review agent examines the case and has the authority to determine as to whether the medical claim should be covered.

Decision in a dispute between a patient and an insurer by an independent review organization certified by the state.