Patients Gain Rights to Appeal Health Insurance Claims

This past week the White House has issued regulations to make it
easier for consumers to appeal denials from health insurance claims. The new
regulations will give consumers the right to appeal denials of claims to health
insurance companies and then to external review boards.

According to Kaiser Health News,
45 states already have rules and regulations pertaining to appealing health insurance
claims to external reviews. Only five states do not guarantee consumers the
right to external reviews and many states have varying degrees of regulations.

These new regulations from the White House will
make laws and regulations over external reviews uniform across the country.

Phyllis Borzi, assistant secretary at the
Department of Labor, said, “This is a regulation that benefits everyone — consumers
get protections, business and providers get more certainty in the rules and the
need for litigation to settle these issues should be dramatically
minimized.”

The new regulations will not apply to grandfathered
plans, which are plans that were active before health care reform was passed.
Group health insurance plans that lose their grandfathered status in the future
will abide by these new rules.

These new regulations will apply to new health
insurance plans starting on September 23, 2010.

However, states have until July of next year to
change regulations to meet these requirements or the federal government will
provide the new protections to residents.

Many consumers do not take advantage of appeals
processes but around 40 percent of health insurance denials are reversed by external
review boards.

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