New Rules under Reform Promise Smoother Appeals Process for Claim Denials

[This article posted on July 26, 2010. It is posted within the following categories: Corporate, Politics & The Law, via Michael Douglas, MD, MBA.]

Got a gripe with your health insurer? You may be in luck. Under the new reform law, President Obama is making it easier to file appeals and have them evaluated because of a rejected claim. Prior to reform, the appeals process differed among insurers, adding to the bureaucratic “justification” for the rather phlegmatic approach to such issues in the past.

Now, consumers will appeal directly to the insurer. If they’re denied a second time, they can go to an independent reviewer whose decision is binding. Health plans must pay the cost of outside appeals, and if they’re overruled, they must cover the disputed claim in full. Consumers can also use the appeals process if their coverage gets canceled. The program will benefit almost 90M policyholders by the law’s totality in 2014. | LINK

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