Feds move to improve health insurance appeals
Feds move to improve health insurance appeals
0 Comments | Charleston Daily Mail, Jul 23, 2010 | by RICARDO ALONSO-ZALDIVAR
WASHINGTON – The Obama administration took the first step Thursday to guarantee that consumers can appeal to a neutral referee if their health insurance company denies a medical claim.
However, because health insurance and President Barack Obama’s overhaul law are both complicated, the new federal safeguards will not immediately apply to most Americans with private coverage.
The regulations issued Thursday spell out a two-stage process for appeals, administration officials said.
First, 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. And the rules provide for expedited decisions in medically urgent circumstances.
Although most health plans already have a system for appeals – and 44 states provide for some form of outside review – the federal rules are more stringent with insurers and friendlier to consumers
guaranteed issued health insurance
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