Pennsylvania Governor Josh Shapiro @GovernorShapiro
If Your Life or Health is at Serious Risk
For urgent requests, please select an Expedited Independent External Review in your application.
We launched a new tool that lets you request a review of any health insurance claim that you believe was wrongfully denied in less than five minutes on your phone.
It’s easy to use and will help Pennsylvanians get the critical care they need.
Request a Review of Denied Health Insurance Claims
If your health plan has denied a service, treatment, or item, you may be eligible to request a review of the decision. The Independent External Review allows you to share why your request should be covered.
If Your Life or Health is at Serious Risk
For urgent requests, please select an Expedited Independent External Review in your application. Submit a request as soon as you receive the initial notification from your health plan. You will still need to file an internal appeal with your health insurance. Unlike the standard process, DO NOT WAIT for the internal appeal process to be completed.
You must submit a Physician Certification Form to confirm the service, treatment, or item is lifesaving.
https://iro.insurance.pa.gov/content/dam/copapwp/act-146/physician-certification.pdf
An independent group of experienced doctors and healthcare professionals will review your case. If the review determines that the request should be covered, your health plan must do so. Independent review decisions are final and binding.