Wiki Self Insured Commercia policies and External Appeals IRO

[orthobiller2017]

Hi- after provider appeals exhausted, for commercial self insured plans, can providers request IRO or is that only eligible to the patients/subscribers?

 

[CBLENNIE]

The Federal Safe Harbor External Review rights are only available to the patient, or their authorized representative. If the financial liability lies with the provider and the patient has not financial liability, then they don't have internal or external appeal rights.