(1) An insured seeking an external review shall pay a fee of $25.00, which shall accompany the request for a review, to the Office of Patient Protection.(a) No insured shall be required to pay more than $75 in fees for external review requests per plan year, regardless of the number of external review requests submitted.(b) If the $25 fee has been paid, the Office of Patient Protection shall refund the $25 fee to the insured if the adverse determination is reversed or overturned in its entirety by the external review agency.(2) The Office of Patient Protection shall waive the fee for any insured with a total household income that does not exceed 300% of the federal poverty level or if it determines that the payment of the fee will result in extreme financial hardship to the insured.(3) The remainder of the cost for an external review shall be borne by the involved carrier. Upon completion of the external review, the Office of Patient Protection or the external review agency shall bill the involved carrier the amount established pursuant to contract between the Commission and the assigned external review agency minus the $25 fee when this fee is the insured's responsibility. When the insured is not required to pay the fee pursuant to 958 CMR 3.402(l)(a) or (2) or the insured's fee is refunded pursuant to 958 CMR 3.402 (1)(b), the carrier shall be responsible for paying the full cost of review, including the $25 fee.Amended by Mass Register Issue 1494, eff. 4/28/2023.