Citi Benefits Handbook
MCMC External Claim Review
External Review is a review of an eligible Adverse Benefit Determination or a Final Internal Adverse Benefit Determination by an Independent Review Organization/External Review Organization (ERO) or by the State Insurance Commissioner, if applicable.
A Final External Review Decision is a determination by an ERO at the conclusion of an External Review.
You must complete all of the levels of standard appeal described above before you can request External Review, other than in a case of Deemed Exhaustion. Subject to verification procedures that the Plan may establish, your authorized representative may act on your behalf in filing and pursuing this voluntary appeal.
You have the right to file a request for an External Review with the Plan if the request is filed within four months after the date of receipt of this notice of an Adverse Benefit Determination. If there is no corresponding date four months after the date of receipt of such a notice, then the request must be filed by the first day of the fifth month following receipt of this notice. To request this appeal, use the contact information below:
ERISA Appeal Team
Express Scripts Appeal Program
300 Crown Colony Drive, Suite 203
Quincy, MA 02169
Telephone: 1 (800) 652-4840
Fax: 1 (800) 882-4715