Code of Massachusetts Regulations
958 CMR - HEALTH POLICY COMMISSION
Title 958 CMR 3.000 - Health Insurance Consumer Protection
Section 3.401 - Expedited External Review
Current through Register 1518, March 29, 2024
(1) An insured or the insured's authorized representative may request to have the request for review processed as an expedited external review.
(2) Each request for an expedited external review shall contain a certification, in writing, from a health care professional responsible for the treatment or proposed treatment that delay in the provision or continuation of health care services that are the subject of a final adverse determination, would pose a serious and immediate threat to the health of the insured.
(3) Upon receiving a properly executed certification that a serious and immediate threat to the insured exists, the Office of Patient Protection shall qualify such request as eligible for an expedited external review.
(4) The insured or insured's authorized representative may file a request for expedited external review concurrently with a request for expedited internal review.
(5) The external review agency shall issue a decision within 72 hours of receiving the request for expedited external review.
