Michigan’s Appeals System ‘Efficient’ But Underutilized, Report Says

Michigan's system allowing patients to appeal health insurance companies' decisions to deny coverage is "well-managed" and efficient, but it should be "better publicized," according to a report released last week by AARP Michigan, the AP/Detroit News reports. Under the system, which took effect in October 2000, patients can file an appeal to the state within 60 days after their health insurance company denies them coverage. The appeal, if accepted by the state, is then reviewed by an independent panel of health practitioners, who determine whether the insurer was justified in denying the claim. State records show that in the program's first 16 months, 418 individuals registered appeals. Of those cases, 36 were dismissed, 72 were resolved without further review and 309 cases were accepted for full review; the state found in favor of the patient in 46% of the cases accepted for full review. "The new independent external review process for insurance and HMO complaints is a great tool for consumers, but this report shows that it is woefully underutilized," Sarah Slocum, associate director of AARP Michigan said, adding, "A right is only useful if people know about it." Michigan Insurance Commissioner Frank Fitzgerald said he was "pleased" by the AARP's findings, adding, "This program really does work, and that the AARP has studied it and is saying that it deserves wider recognition is a real positive." Fitzgerald said many people may be hesitant to file appeals because they "don't think that [government programs are] going to benefit them." The state and AARP Michigan are planning to publicize the appeals program with brochures and speeches to community groups. Fitzgerald also urged consumers to "carefully" read any materials sent to them by their insurance company and to notify state officials if the appeals process is not explained (Durbin, AP/Detroit News, 6/15).