Internal appeal
The first formal review of a denial — conducted by the plan itself, by someone other than the original decision-maker.
Internal appeal is the plan's own reconsideration of its denial. Federal law requires the review be conducted by a qualified person other than the original decision-maker and (for clinical questions) by a qualified health-care professional. Most plans have one or two internal levels. Internal appeal is the mandatory first step before external review.
Frequently asked questions
What is internal appeal?
Internal appeal is the plan's own reconsideration of its denial. Federal law requires the review be conducted by a qualified person other than the original decision-maker and (for clinical questions) by a qualified health-care professional. Most plans have one or two internal levels. Internal appeal is the mandatory first step before external review.
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