In both the House and Senate Republican leadership bills, the insurance company selects and pays for the external appeals entity. They report their decision to the plan. The plan selects a physician, who can work for the plan, to review that decision and make a recommendation. Even then, any recommendation is not binding on the plan. In the Senate bill, S. 2330, the plan also picks the external review entity, which could be a hospital under contract to the plan.
Patients have no role in the selection process.
The Department of Labor and state authorities are given specific authority to ensure that the selection process is not biased. Not Guaranteed the Right to Present their Case. The House and Senate Republican leadership bills do not guarantee patients, their representatives or treating physicians the right to present evidence to the appeals entity. That entity is limited to reviewing documentation provided by the plan from the internal review process. The House bill would not even let patients know who is reviewing their appeal.