Expedited External Medical Appeal. An Expedited External Appeal is a request for immediate review, by an Independent Review Organization (IRO). The request may be simultaneously filed with a request for an internal Expedited Appeal, since the Independent Review Organization assigned to conduct the expedited external review will determine whether the request is eligible for an external review at the time of receipt. We will forward all pertinent information for Expedited External Appeal requests to the IRO so the review may be completed within seventy-two (72) hours of receipt.
Expedited External Medical Appeal. An Expedited External Review is a request for immediate review, by an Independent Review Organization (IRO) randomly assigned by the Louisiana Department of Insurance, of an initial Adverse Determination not to Authorize continued services for Members currently in the emergency room, under observation in a facility or receiving Inpatient care. Expedited External Appeals are not provided for review of services previously rendered. An Expedited External Appeal of an adverse decision is available if pursuing the standard Appeal procedure could seriously jeopardize the Member’s life, health or ability to regain maximum function; or when in the opinion of the treating physician, the Member may experience pain that cannot be adequately controlled while waiting for a decision on a second level standard Appeal. An Expedited External Appeal is also available if the Adverse Determination involves a denial of coverage based on a determination that the recommended or requested health care service or treatment is deemed experimental or Investigational; and the covered person's treating Physician certifies in writing that the recommended or requested health care service or treatment that is the subject of the Adverse Determination would be significantly less effective if not promptly initiated. The request may be simultaneously filed with a request for an expedited internal review, since the Independent Review Organization assigned to conduct the expedited external review will determine whether the request is eligible for an external review at the time of receipt. We will forward all pertinent information to the IRO so the review is completed no later than seventy- two (72) hours of receipt. Any decision rendered by the IRO is binding on Us and the Member. This Appeals process shall constitute the Member’s sole recourse in disputes concerning determinations of whether a health service or item is or was Medically Necessary, except to the extent that other remedies are available under State or Federal law.
Expedited External Medical Appeal. An Expedited External Appeal is a request for immediate review, by an Independent Review Organization (IRO). The request may be simultaneously filed with a request for an internal Expedited Appeal, since the Independent Review Organization assigned to conduct the expedited external review will determine whether the request is eligible for an external review at the time of receipt. We will forward all pertinent information for Expedited External Appeal requests to the IRO so the review may be completed within seventy-two (72) hours of receipt. For all medical Appeals, the Office of Consumer Advocacy of the Department of Insurance is available to assist with the appeals process. You may contact the Commissioner of Insurance directly for assistance at: Commissioner of Insurance P. O. Box 94214 Baton Rouge, LA 70804-9214 0-000-000-0000 or 0-000-000-0000 ARTICLE XI. HOW TO MAKE POLICY CHANGES AND FILE CLAIMS Blue Cross and Blue Shield of Louisiana is continuing to update its online access for Subscribers. The Subscribers may now be able to perform many of the functions described below, without contacting Our customer service unit. We invite the Subscribers to log on to xxx.xxxxxx.xxx for access to these services.
