Obama Administration Relaxes Rules on Claims for Denials of Insurance
On Thursday, the Obama administration issued new rules that will ease patients' ability to appeal health insurance claim denials, Kaiser Health News/Washington Post reports.
The regulations guarantee that residents can appeal denials directly to insurers and then to an external review board, if necessary.
States Eligible for Grant Money
Most states already guarantee consumers the ability to appeal to external review boards. However, the rules vary among states, and many consumers are unaware of their right to appeal.
Under the new regulations, states will be entitled to $30 million in grant money to strengthen customer assistance offices.
In addition, the rules for the first time will apply the external review requirement to companies that self-insure.
In a fact sheet, administration officials wrote, "The rules issued today will end the patchwork of protections that apply to only some plans in some states, and simplify the system for consumers."
Officials Say Millions Will Benefit
Officials estimate that by 2011, 31 million people in employer-sponsored plans and 10 million more in individual plans will benefit from the regulations.
However, the rules will not apply to "grandfathered" plans that existed before the new health reform law was enacted in March. Plans can lose the grandfathered status if they make significant changes in cost or benefits.
The regulations take effect for plan years starting Sept. 23, but will not apply to residents in states that already have external review laws until next July, giving those states time to adjust their rules.
The regulations suggested states that adopt the new standards by July 2011. Administration officials said they hope that states without an external review system will establish one using the new regulations. If the states do not, the federal government will create one for them (Galewitz/Andrews, Kaiser Health News/Washington Post, 7/22).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.