External Review Request Letter
Builds an external review request with its four-month deadline.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Date the final internal denial was received
- 2026-08-31
- Claimant name
- Pat Doe
- Member ID
- X123
- Plan or issuer name
- Acme Health
- Service, drug or item denied
- an MRI
- Request date
- 2026-09-20
Result: The request is due by December 31, 2026. 1 blank left to fill before sending.
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Date the final internal denial was received (YYYY-MM-DD)
- Claimant name
- Member ID
- Plan or issuer name
- Service, drug or item denied
- Ask for an expedited external review
- The plan did not follow the internal-appeal rules (deemed exhaustion)
- Request date (YYYY-MM-DD; blank for today)
How this is calculated
Citation
45 CFR 147.136: external review requested within 4 months of receiving the final internal denial; expedited when the standard timeframe would seriously jeopardize life, health or the ability to regain maximum function; deemed exhaustion when a plan fails the appeal rules. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.