Appeals Rule Causes Disagreements Between Insurers And Consumer Groups
The right to appeal a denial of service, reducing of or cancellation of health benefits is a provision in the brand new health care law. Three plans are included -- bulk, self-insured, and an individual. Plans that existed before the law will have grandfather status, so the provision will not apply to those plans.
Rules regarding a new health care regulation, were published in July of last year. The new rules include the provision that insurers must explain to patients about any decisions, plus offer the appeals process. Insured people can appeal any decisions made regarding their health plan, as well as being entitled to an external review. The rules also include the period of time for patients to appeal and for insurers to respond.
External appeals processes were already available in some states, however, these processes varied from state to state. Some health plans didn't follow appeal results but now they must all comply.
A grace period exists so that insurers may comply with the law. For plans renewed or started after September 23rd, July 1st is the cutoff date. The government asked insurers and consumers to comment.
Insurance companies wanted some amount of revisions made. There is a 24-hour deadline for reviewing urgent requests for coverage and insurers want that timeframe expanded. Insurers also requested tighter rules regarding the ability of patients to request external reviews of coverage decisions. Insurers also want to cancel the need to give non-English patients a written description of the appeals process.
Robert Zirkelbach from America's Health Insurance Plans stated that the recommendations made by insurers would only improve the appeals process. He states that insurer suggestions can only work to make the process more efficient and it will work better.
Consumer organizations and patient advocates want recommendations to be rejeted|passed on}, because they don't like them}. They felt that the recommendations from insurers only served the companies' best interests, and not patients. "These rules offer crucial protection to people who are denied medical services, and who, in the past, had no other recourse," states Cheryl Fish-Parcham, deputy policy director at Families USA, a health advocacy group
Advocacy for Patients With Chronic Illness, Families USA, National Woman's Law Center and Health Access California -- all advocacy groups -- forwarded a letter to Karen Pollitz with the office of Consumer Support at the Dept. of HHS, as well as to Phyllis Borzi of the Employee Benefits SS Admin. at the Dept. of Labor. The consumer groups are urging that the insurer recommendations not be implemented.
24 hour insurer response to urgent requests isn't always necessary|Zirkelbach, a health industry spokesman, said that a twenty-four hour response to urgent requests is not always needed|Mr. Zirkelbach, a spokesman for the health industry, replied that a twenty-four hour response from insurers is not always needed}. He said that emergency and urgent care are different, so that a twenty-four hour response time isn't necessary. He also stated that there is difficulty in translating some insurance terms for non-English speakers, so it's easier to explain in person rather than in written form.
Compliance with new health laws by July 1st may not be feasible. Health insurers are encountering problems when trying to contract with organizations that handle independent medical reviews.
Senior vice president of AHIP, Jeffery Gabardi, feels that delays in implementation of rules would not penalize individuals, but would instead allow time to establish a more universally appealing process without additional complexity or cost.
Rules regarding a new health care regulation, were published in July of last year. The new rules include the provision that insurers must explain to patients about any decisions, plus offer the appeals process. Insured people can appeal any decisions made regarding their health plan, as well as being entitled to an external review. The rules also include the period of time for patients to appeal and for insurers to respond.
External appeals processes were already available in some states, however, these processes varied from state to state. Some health plans didn't follow appeal results but now they must all comply.
A grace period exists so that insurers may comply with the law. For plans renewed or started after September 23rd, July 1st is the cutoff date. The government asked insurers and consumers to comment.
Insurance companies wanted some amount of revisions made. There is a 24-hour deadline for reviewing urgent requests for coverage and insurers want that timeframe expanded. Insurers also requested tighter rules regarding the ability of patients to request external reviews of coverage decisions. Insurers also want to cancel the need to give non-English patients a written description of the appeals process.
Robert Zirkelbach from America's Health Insurance Plans stated that the recommendations made by insurers would only improve the appeals process. He states that insurer suggestions can only work to make the process more efficient and it will work better.
Consumer organizations and patient advocates want recommendations to be rejeted|passed on}, because they don't like them}. They felt that the recommendations from insurers only served the companies' best interests, and not patients. "These rules offer crucial protection to people who are denied medical services, and who, in the past, had no other recourse," states Cheryl Fish-Parcham, deputy policy director at Families USA, a health advocacy group
Advocacy for Patients With Chronic Illness, Families USA, National Woman's Law Center and Health Access California -- all advocacy groups -- forwarded a letter to Karen Pollitz with the office of Consumer Support at the Dept. of HHS, as well as to Phyllis Borzi of the Employee Benefits SS Admin. at the Dept. of Labor. The consumer groups are urging that the insurer recommendations not be implemented.
24 hour insurer response to urgent requests isn't always necessary|Zirkelbach, a health industry spokesman, said that a twenty-four hour response to urgent requests is not always needed|Mr. Zirkelbach, a spokesman for the health industry, replied that a twenty-four hour response from insurers is not always needed}. He said that emergency and urgent care are different, so that a twenty-four hour response time isn't necessary. He also stated that there is difficulty in translating some insurance terms for non-English speakers, so it's easier to explain in person rather than in written form.
Compliance with new health laws by July 1st may not be feasible. Health insurers are encountering problems when trying to contract with organizations that handle independent medical reviews.
Senior vice president of AHIP, Jeffery Gabardi, feels that delays in implementation of rules would not penalize individuals, but would instead allow time to establish a more universally appealing process without additional complexity or cost.