Patients Gain Rights to Appeal Health Insurance Claims
Posted on July 21st, 2010
This past week the White House has issued regulations to make it easier for consumers to appeal denials from health insurance claims. The new regulations will give consumers the right to appeal denials of claims to health insurance companies and then to external review boards.
According to Kaiser Health News, 45 states already have rules and regulations pertaining to appealing health insurance claims to external reviews. Only five states do not guarantee consumers the right to external reviews and many states have varying degrees of regulations.
These new regulations from the White House will make laws and regulations over external reviews uniform across the country.
Phyllis Borzi, assistant secretary at the Department of Labor, said, “This is a regulation that benefits everyone — consumers get protections, business and providers get more certainty in the rules and the need for litigation to settle these issues should be dramatically minimized.”
The new regulations will not apply to grandfathered plans, which are plans that were active before health care reform was passed. Group health insurance plans that lose their grandfathered status in the future will abide by these new rules.
These new regulations will apply to new health insurance plans starting on September 23, 2010.
However, states have until July of next year to change regulations to meet these requirements or the federal government will provide the new protections to residents.
Many consumers do not take advantage of appeals processes but around 40 percent of health insurance denials are reversed by external review boards.
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Tags: Claims, Health Insurance, Health Insurance Claims, Insurance Claims
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