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Managed Care Nursing

Category - Patient Issues

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An insurance company denies a claim, and the patient appeals to a third party for a review of the decision.

Which of the following matches the above scenario?

Appeals review
Interagency review
External review
Third party review

Explanation

Answer: C- An external review occurs when an insurance company denies a claim and the patient appeals to a third party.

The final decision is up to the third party reviewer.

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