But in some of those states, requests for post-stabilization treatment approval that receive no response within a specified time period are automatically approved. Other states, however, impose no time restraints on how long a plan can take to respond to a request for post-stabilization care and do not automatically approve care despite the plan's failure to respond. Another area demonstrating the variability of state consumer protection laws is the one relating to external or independent reviews of health service denials. A majority of states have passed independent review legislation. But the breadth and scope of these provisions vary from state to state, providing consumers absolutely no consistent protection.
Some states reserve independent external review for determinations of medical necessity.
Other states allow independent external reviews to settle any consumer grievance not resolved internally by the plan. The make-up of the independent review entity can again vary depending on the state. In some states reviews are performed by physicians or providers who are experts in the treatment of the enrollee's conditions. Other state laws preclude members of independent review boards from having been involved in the initial denial of care or from having a direct financial interest in the outcome of the review. Some states require the Director of Insurance to compile a list of independent review entities.