The rules, delayed from July until next January, include:
1. Reducing the maximum time the payor is given to review a denial in urgent cases from 72 hours to 24 hours.
2. Requiring payors to explain the denial and how to appeal it in appropriate language for non-English speaking beneficiaries.
3. Mandating inclusion of specific details, including diagnostic codes, on what treatment isn’t covered and why.
The Department of Labor, which oversees enforcement of the rules, said it intends to modify them “in the near future.” The department said its decision “struck a balance” in responding to comments on the rules by a variety of groups.
In those comments, America’s Health Insurance Plans, representing private payors, said providing detailed explanations on diagnostic codes would be an administrative burden and could even delay getting denial notices to beneficiaries.
Read the Kaiser Health News report on healthcare reform.
Read the Department of Labor announcement.
Read more coverage of consumer protections in the healthcare reform law.
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