Health News
So, what exactly is an external review?
It means having an independent third party review your insurer?s decision, no matter where you live, thanks to the Affordable Care Act. Often, you can resolve disputes with your health plan by asking your insurer to reconsider its decision, in a process known as an ?internal appeal.? But if, for example, your insurer still denies payment after the internal appeals process, you now can ask for an external review by an independent review organization to decide the matter. Insurance companies must accept the outcome of this external review. This means that your insurance company no longer gets the final say, and that patients and doctors get a greater measure of control over health care decisions.
These protections are important because when an insurer refuses to pay for a covered health care service, consumers could be faced with a large unplanned bill, and may not be able to afford the care their doctors say they need.
The Affordable Care Act sets these new important appeals standards for consumer protections and encourages States to take the lead in ensuring their own residents benefit from them. Where States have not yet passed laws implementing these consumer protections, HHS has set up a process to ensure that consumers in these States also benefit from the same protections and standards. If a State changes its external review process in the future, the State may request a new determination at any time.
Having DC, Massachusetts, New Hampshire, Ohio and Wisconsin step up to the plate to ensure consumers? external review rights is a perfect example of how the Affordable Care Act empowers States to protect consumers.
This post was originally published on The HealthCare Blog on November 22, 2011
By Eliza Bangit, Acting Director of the Consumer Support Group
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Health News
States Taking the Lead in Strengthening Consumer Protection
Recently, five more States strengthened their laws protecting consumers in disputes with their health insurance plans. The District of Columbia, Massachusetts, New Hampshire, Ohio and Wisconsin have bolstered their laws surrounding the part of the appeals process known as ?external review.? These five States join 33 others that provide these State-based external review protections that ensure consumers have a voice. The remaining States? consumers are protected by a Federal process.
The strengthened appeals rights are one of several common-sense consumer protections and insurance market reforms established by the Affordable Care Act. Having a meaningful appeals process ensures that you actually receive the benefits that your insurer has promised.
The strengthened appeals rights are one of several common-sense consumer protections and insurance market reforms established by the Affordable Care Act. Having a meaningful appeals process ensures that you actually receive the benefits that your insurer has promised.
So, what exactly is an external review?
It means having an independent third party review your insurer?s decision, no matter where you live, thanks to the Affordable Care Act. Often, you can resolve disputes with your health plan by asking your insurer to reconsider its decision, in a process known as an ?internal appeal.? But if, for example, your insurer still denies payment after the internal appeals process, you now can ask for an external review by an independent review organization to decide the matter. Insurance companies must accept the outcome of this external review. This means that your insurance company no longer gets the final say, and that patients and doctors get a greater measure of control over health care decisions.
These protections are important because when an insurer refuses to pay for a covered health care service, consumers could be faced with a large unplanned bill, and may not be able to afford the care their doctors say they need.
The Affordable Care Act sets these new important appeals standards for consumer protections and encourages States to take the lead in ensuring their own residents benefit from them. Where States have not yet passed laws implementing these consumer protections, HHS has set up a process to ensure that consumers in these States also benefit from the same protections and standards. If a State changes its external review process in the future, the State may request a new determination at any time.
Having DC, Massachusetts, New Hampshire, Ohio and Wisconsin step up to the plate to ensure consumers? external review rights is a perfect example of how the Affordable Care Act empowers States to protect consumers.
By Eliza Bangit, Acting Director of the Consumer Support Group
- Former Head Of Massachusetts Health Exchange Says It's Better To Offer Fewer, Well-defined Plans Than Set General Criteria
With Kentucky stakeholders discussing their options to set up a state-run health insurance exchange ? something Gov. Steve Beshear said last week he intends to do if the Affordable Care Act is upheld by the U.S. Supreme Court ? research shows the...
- Clearing Up The Facts
There has been a lot of confusion about some recent notices to consumers from insurance companies that sell coverage in the individual insurance market, and I?d like to clear up the facts. Today, more than 3 out of every 4 Americans get insurance from...
- States Take Steps To Improve Oversight And Consumer Engagement
In the past few months, several states have taken dramatic steps to strengthen their rate review authority, protect consumers, and call out insurers on excessive rate increases. For example, earlier this year, California health insurers announced planned...
- Action Alert: Tell Senator Cullerton To Stand Up For Working Families & Small Businesses In Illinois!
1. Call IL Senate President Cullerton TODAY! Toll-free number to the Capitol: 1.888.616.3322 Springfield Office: 217.782.2728 Chicago District Office: 773.883.0770 Tell him: OPPOSE the insurance industry supported health exchange bill - SUPPORT Passage...
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It's been a year since the historic vote that made the Affordable Care Act (ACA) a law, putting America on the path towards a system of quality, affordable health care for all. We have a lot to celebrate as we continue to implement and enforce our...