US Medical Term · insurance
External Review
Revisión Externa
In 9 languages
| Language | Term |
|---|---|
| English | External Review |
| Spanish (Español) | Revisión Externa |
| Chinese (中文) | 外部审查 |
| Korean (한국어) | 외부 심사 |
| Vietnamese (Tiếng Việt) | Xem xét bên ngoài |
| Filipino (Tagalog) | Panlabas na Pagsusuri |
| Portuguese (Português) | Revisão Externa |
| Thai (ภาษาไทย) | การตรวจสอบภายนอก |
| Japanese (日本語) | 外部審査 |
What it means
External review is an independent, binding evaluation of your health insurer's denial by an outside organization not affiliated with the plan. Under the ACA, you have the right to request external review after exhausting your plan's internal appeal process—or immediately in urgent situations. An independent review organization (IRO) staffed by certified medical specialists examines the case without deference to the insurer. If the IRO rules in your favor, the insurer must comply and provide coverage or pay the claim. Federal external review rules apply to most employer plans and Marketplace plans. Grandfathered or self-insured employer plans may follow state or alternative federal processes. External review decisions are final and binding for both parties.
How to say it
Sentences a patient might use with a doctor, nurse, pharmacist, or insurer:
After the internal appeal was denied, I requested an external review from an independent review organization.
Después de que se negó la apelación interna, solicité una revisión externa de una organización de revisión independiente.
The external reviewer sided with me, and the insurer was required to cover the procedure that had been denied.
El revisor externo falló a mi favor, y la aseguradora estuvo obligada a cubrir el procedimiento que había sido denegado.
Under federal rules, you have four months from the final internal denial date to request external review.
Según las reglas federales, tiene cuatro meses desde la fecha de denegación interna final para solicitar una revisión externa.
Where you'll see it
Related terms
Sources
Last reviewed: September 2026