The earlier rules governed consumers’ right to appeal denials by health plans. The overhaul gave members in group and individual health plans the right to appeal the denial of coverage to an independent review panel. The administration’s new rules give beneficiaries less time to prepare an appeal, less information about the reason for the denial and limitations on which denials can be appealed.
According to the report, patients can still appeal if their coverage is canceled by an insurer, and decisions by external review panels are still binding. Employer-sponsored plans that are self-insured will have to use at least two independent review organizations to make sure decisions remain unbiased.
Consumer advocates worry that the decision to shorten the time period to prepare an appeal from 120 days to 60 days will not leave enough time to obtain medical records, get letters from physicians and prepare the appeal.
Read the Kaiser Health News report on health insurance appeals.
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