Examples of Adverse determination in a sentence
You or your authorized representative must submit a written request for a standard external independent review to the Illinois Department of Insurance (“IDOI”) within 4 months of receiving an Adverse Determination or Final Adverse Determination.
For appeals relating to a determination based on treatment being experimental or investigational, the Plan will complete a preliminary review to determine whether the requested service or treatment that is the subject of the Adverse Determination or Final Adverse Determination is a Covered Service, except for the Plan's determination that the service or treatment is experimental or investigational for a particular medical condition and is not explicitly listed as an excluded benefit.
You or your authorized representative may make a request for a standard external review or expedited external review of an Adverse Determination or Final Adverse Determination by an independent review organization (IRO).