Which statement best describes an internal appeal?

• A. It is reviewed by an independent external organization.
• B. It is reviewed by the insurer’s internal review team.
• C. It is submitted directly to the employer for approval.
• D. It is handled by the patient’s attorney.

Answer: (B)

An internal appeal is the process of challenging a plan decision within the insurer’s own system. The review is handled by the plan’s own staff—often medical directors or utilization review teams—reconsidering the denial to see if medical necessity, coverage, or coding errors were applied correctly. This stays inside the insurer’s procedures and paths, before any external steps.

That’s why the best description is that it is reviewed by the insurer’s internal review team. It’s not handled by an independent external organization, nor is it submitted to the employer for review or handled by the patient’s attorney, which would involve external review or legal action rather than the plan’s internal reconsideration process.