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Question What can I do if I am denied health care services on the basis that the services are not medically necessary?

Answer External review provides an independent appeal process for New Yorkers who have been denied health insurance benefits for reasons of medical necessity. Medical professionals who are not affiliated with your HMO or health insurer review the merits of your case and issue a determination. These professionals are called certified external appeal agents. Prior to the Law, aggrieved consumers were limited to filing internal appeals through their health plans or filing lawsuits.

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External Review Forms and Instructions

Comprehensive information about External Review including forms, instructions and additional FAQ's.
URL: http://www.dfs.ny.gov/insurance/extapp/extappqa.htm
E-mail:Externalappealquestions@dfs.ny.gov
Phone: 800-400-8882

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