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Administration Unveils Rules for Third-Party Review of Denied Health Claims

The AP reported, “The Obama administration says most Americans will soon have the right to appeal to a third party referee when their health insurer denies a claim for a medical service.” The regulations “released Wednesday carry out provisions of President Barack Obama’s health care law. Insurers generally give customers a couple of chances to appeal internally, but access to outside review varies.”

The Washington Post reported that the new rules change “the standards in ways that disappointed leading advocates for health-care consumers.” The regulations “are intended to guarantee patients nationwide the same rights to appeal if their insurers do not cover care that they consider necessary. The federal standards…replace a patchwork of separate state policies.” HHS “officials issued the rules 11 months ago, but they have been working to fine-tune them amid a blizzard of lobbying. Insurers and employers have been urging limited rights to appeal, while consumer groups have been arguing for stronger patient protections.”

The Wall Street Journal said that the Administration is delaying the effective date of these rules until January 1 of 2012. They were supposed to take effect in July.

CQ reported that the regulations give “states until January 1, 2012 to adjust their insurance regulations to comply with a health law requirement that health plans establish a process for enrollees to appeal claim denials within the company and to take their complaints to an external review board if need be.”

From the American Association for Justice news release.

Bob Kraft

I am a Dallas, Texas lawyer who has had the privilege of helping thousands of clients since 1971 in the areas of Personal Injury law and Social Security Disability.

About This Blog

The title of this blog reflects my attitude toward those government agencies and insurance companies that routinely mistreat injured or disabled people. As a Dallas, Texas lawyer, I've spent more than 45 years trying to help those poor folk, and I have been frustrated daily by the actions of the people on the other side of their claims. (Sorry if I offended you...)

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