Health Law Gives Consumers New Rights To Appeal Insurer Decisions

Los Angeles Times: The Obama administration issued regulations yesterday addressing a top consumer gripe with health insurers: The rejected claim. "Rejection notices are often unclear, as are the procedures for challenging them." The new regulations are "designed to simplify the process and expand consumers' rights, as required by the recently enacted healthcare law." Current appeals rules differ by insurer. The regulations will standardize the process, allowing consumers to first take their complaints to the insurer, and then to an independent review panel (Levey, 7/22).

The Associated Press: "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" (Alonso-Zaldivar, 7/22).

The Wall Street Journal's Health Blog: "The new rules [also] apply to health plans that are self-funded by employers, which haven't always been subjected to external-review requirements, says [consumer advocacy group Families USA head Ron] Pollack. They do not, however, apply to plans 'grandfathered' in under health-care overhaul legislation, which means they're not subject to some of the provisions of the law" (Hobson, 7/22). 

USA Today: "The regulations will apply to new health plans that begin on or after Sept. 23. Most health plans have policy years that start Jan. 1." Existing plans won't have to comply with the rules unless they change their benefits or cost-sharing significantly. (Young, 7/22).

The Hill: "the administration estimates the program will benefit 41 million Americans next year and 88 million in 2013. ... Thursday's announcement is the latest in a series of White House efforts to publicize each new benefit of the controversial reform law that comes along" (Lillis, 7/22).

Earlier, related KHN coverage: New Rules Guarantee Patients' Right To Appeal Insurance Claim Denials (Galewitz and Andrews, 7/22).