Are You Taking Advantage of The New Health Insurance Appeals Process?

Written by yvonnethornton on June 15th, 2011

One of the big advantages of the Affordable Care Act (a.k.a. the healthcare reform bill) is that millions of Americans who once had no recourse when their insurers turned them down for coverage, now can appeal. Insurance company turns you down for a transplant? Appeal. Says no to a life-saving procedure? Appeal. Insists that you have to pay for something you believe is covered under your policy? Appeal.

And your appeal won’t be decided by the same administrator who turned you down in the first place. Under the new healthcare reform law, health insurance appeals are decided by an independent decision-maker, one who has no financial stake in the outcome.

This provision can be a lifesaver … but only if you know about it and act on it within the 180-day timeframe permitted.

According to Kaiser Healthcare News:

The provision took effect for most plans Jan. 1. But in response to self-insured plans’ concerns about being able to meet some of the requirements, the government said it wouldn’t require the plans to tell members about their external appeals rights until plan years beginning after July 1. Since most plans start their new year in January, that means they won’t have to notify members about their right to external appeals and how to file them until next year.

However, the government isn’t granting enrollees more time to file appeals, said an official at the Department of Health and Human Services, who spoke only on the condition of not being identified. Patients have 180 days from the date of initial denials to file internal appeals to the plan. If the appeals are rejected, they then have another four months to appeal to outside arbiters.

If nobody tells patients about their rights, this provision, in other words, might not be discovered by the people who need it most until it’s too late.

So, I’m urging you to link to this post wherever you can: Facebook, Twitter, Reddit, any and all social networks. Explain the need to be informed. Tell your friends and family: you have a right to appeal. For some, it can be a matter of life and death.

Don’t let the chance slip away.

– Yvonne S. Thornton, MD, MPH

 

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