Section 3.314 - Internal Review ConferenceNothing in 958 CMR 3.000 shall be construed to prohibit an insured or insured's authorized representative from voluntarily participating in a conference or informal meeting with the carrier or utilization review organization to attempt to resolve the subject matter of the grievance.
(1) Any insured or authorized representative of an insured who is aggrieved by a final adverse determination issued by a carrier or utilization review organization may request an external review by filing a request in writing with the Office of Patient Protection within four months of the insured's receipt of written notice of the final adverse determination, except that no final adverse determination is required when the insured simultaneously requests an expedited internal review and expedited external review pursuant to 958 CMR 3.401(4), or where a carrier has waived internal review pursuant to 958 CMR 3.300(3).(2) An insured or insured's authorized representative may file a request for external review for services of any monetary value. There is no minimum financial threshold for filing a request for external review.Amended by Mass Register Issue 1494, eff. 4/28/2023.