Common use of Independent Medical Review; Appeals Rights Clause in Contracts

Independent Medical Review; Appeals Rights. SHL may require an Insured to have an Independent Medical Review prior to issuing Prior Authorization for any medical benefits. In that case, only a Physician or chiropractor who is certified to practice in the same field of practice as the primary treating Physician or chiropractor or who is formally educated in that field will conduct the review. The Independent Medical Review may include a physical exam of the Insured, unless he is deceased, and a personal review of all x-rays and reports made by the primary treating Physician or chiropractor. A certified copy of all reports of findings will be sent to the primary treating Physician or chiropractor and the Insured within ten (10) working days after the Independent Medical Review. If the Insured disagrees with the findings of the Independent Medical Review, he may submit an appeal for binding arbitration to SHL within thirty (30) days after he receives the report. Please refer to the Appeals Procedures section in this AOC for more information.

Independent Medical Review; Appeals Rights. SHL may require an Insured to have an Independent Medical Review prior to issuing Prior Authorization for any medical benefits. In that case, only a Physician or chiropractor who is certified to practice in the same field of practice as the primary treating Physician or chiropractor or who is formally educated in that field will conduct the review. The Independent Medical Review may include a physical exam of the Insured, unless he is deceased, and a personal review of all x-x- rays and reports made by the primary treating Physician or chiropractor. A certified copy of all reports of findings will be sent to the primary treating Physician or chiropractor and the Insured within ten (10) working days after the Independent Medical Review. If the Insured disagrees with the findings of the Independent Medical Review, he may submit an appeal for binding arbitration to SHL within thirty (30) days after he receives the report. Please refer to the Appeals Procedures section in this AOC for more information.

Independent Medical Review; Appeals Rights. SHL may require an Insured to have an Independent Medical Review prior to issuing Prior Authorization for any medical benefits. In that case, only a Physician or chiropractor who is certified to practice in the same field of practice as the primary treating Physician or chiropractor or who is formally educated in that field will conduct the review. The Independent Medical Review may include a physical exam of the Insured, unless he is deceased, and a personal review of all x-x- rays and reports made by the primary treating Physician or chiropractor. A certified copy of all reports of findings will be sent to the primary treating Physician or chiropractor and the Insured within ten (10) working days after the Independent Medical Review. If the Insured disagrees with the findings of the Independent Medical Review, he may submit an appeal for binding arbitration to SHL within thirty (30) days after he receives the report. Please refer to the Appeals Procedures section in this AOC Certificate for more information.