In July, the U.S Department of Health and Human Services (HHS), the Labor Department, and the Treasury Department all came together to announce regulations designed to provide insured consumers with the right to appeal decisions made by their health plans.
The legislation, known as the Affordable Care Act, is designed to ensure that consumers have access to a thorough and uniform appeals process if their health claims are denied.
“Today, if your health plan tells you it won’t cover a treatment your doctor recommends, or it refuses to pay the bill for your child’s last trip to the emergency room, you may not know where to turn,” said HHS Secretary Kathleen Sebelius in a statement. “The Affordable Care Act provisions announced today will provide patients with important new rights and resources that will help ensure they get the care they need.”
The interim rules would provide consumers with:
- The right to appeal decisions made by their health plan through the plan’s internal process.
• The right to appeal decisions made by their health plan to an outside, independent decision-maker, no matter what state consumers live in or what type of health coverage they have.
Most health plans do have a process by which a consumer can file an appeal. However, depending on state law and the type of coverage the consumer has, there is no guarantee of objectivity or swift review. In addition, if that internal review was denied, many consumers had no other avenue of appeal. The new regulations are intended to rectify the problem of consumer protection varying widely from state to state.
One of the biggest protections offered to consumers by this bill is the elimination of arbitrary rescissions of coverage. Prior to this legislation, insurance companies were able to retroactively cancel your policy when you became sick. This act is designed to hold insurance companies more accountable for the decisions they make during the day to day administration of their plans. It puts American consumers in charge of their health coverage and care.