What Do I Do If My Claim Is Denied? Property of Bind Benefits, Inc., d/b/a Surest. All rights reserved © 2026. 63 If one of the above conditions is met, you may request an external review of Adverse Benefit Determinations based upon any of the following: • Medical judgement and/or Clinical reasons — for example Medical Necessity, appropriateness, health care setting, level of care, and effectiveness of a covered Benefit. • A determination that a treatment, service, drug, or device is an Experimental or Investigational Service(s) or Unproven Service(s). • Whether a Participant is entitled to a reasonable alternative standard for a reward under a wellness program. • A determination as to whether a Plan is complying with non-quantitative mental health parity requirements. • Rescission of coverage (coverage that was cancelled or discontinued retroactively). • As otherwise required by applicable law. You or your representative may request a standard external review by sending a written request to the address set out in the determination letter. You or your representative may request an expedited external review, in urgent situations as detailed below, call Surest Member Services or by sending a written request to the address set out in the determination letter. A request must be made within 120 days after the date you received the final internal Adverse Benefit Determination letter from Surest. An external review request should include all of the following: • A specific request for an external review. • The Participant’s name, address, and member ID number. • Your designated representative’s name and address, when applicable. • The service that was denied. • Any new, relevant information that was not provided during the internal appeal. An external review will be performed by an Independent Review Organization (IRO). Surest has entered into agreements with three or more IROs that have agreed to perform such reviews. There are two types of external reviews available, and both are free to you. Standard External Review A standard external review comprises of all of the following: • A preliminary review by Surest of the request completed within five business days following Surest’s receipt of the request. • A referral of the request by Surest to the IRO. • A decision by the IRO.