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**NOTE** - has claimed original rights on the article "Appeals Rule Causes Face Off Between Insurers And Consumer Groups" ... if there is a dispute on the originality of this article ... please contact us via our and supply our staff with the appropriate details of [link widoczny dla zalogowanych] dispute (ie ).
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Wojciech Ciszewski Article Feed :
Article Source: uPublish.info
Find out how to shop for affordable health insurance at medicalhealthinsurancetoday.com. Also read more about the new health care reform at this website.
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Under the new health care law, there's now a right to appeal the reduction, cancellation, or denial of health benefits. Three plans are included -- bulk, self-insured, and single person. The new provision won't apply to plans put in place before the law, due to their [link widoczny dla zalogowanych] grandfather status.
Last July, rules regarding the new health care provision were released. The rules include requiring insurers to explain coverage decisions and tell patients about the appeals procedure if they disagree with the decision. Insured people can appeal any decisions made regarding their own health plan, as well as being entitled to an external review. Appeals and responses are inbuilt into the new regulations.
External appeals processes were already available in some states, however, these processes did vary from state to state. Some health plans did not follow appeal results but now they must [link widoczny dla zalogowanych] 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.
Insurers told the government that they wanted a few revisions made. There is a 24-hour deadline for reviewing urgent requests for coverage and insurers [link widoczny dla zalogowanych] asked for that timeframe expanded. Companies also seek tighter rules about patients being able to get external reviews. Insurers also want to cancel the need to give non-English patients a written description of the appeals process.
Recommendations made by America's Health Insurance Plans could improve the appeals process, says Robert Zirkelbach. He says 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 rejetedpassed on}, because they don't like them}. [link widoczny dla zalogowanych] [link widoczny dla zalogowanych] They decided that implementing those recommendations would only relax the rules for the insurers. "These rules give vital protection to folks who were denied protection, and before this, had no other recourse", [link widoczny dla zalogowanych] says Cheryl Fish-Parcham of Families USA, [link widoczny dla zalogowanych] and who's the deputy policy director there.
Consumer advocate groups such as Advocacy for Patients with Chronic Illness, Families USA, Health Access California and the National Woman's Law Center sent a letter to Karen Pollitz, director of Office of Consumer Support at the Department of Health and Human Services, and Phyllis Borzi, assistant secretary of the Employee Benefits [link widoczny dla zalogowanych] Security Administration at the Department 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 Mr. Zirkelbach, a spokesman for the health industry, replied that a twenty-four hour response from insurers is not always needed}. [link widoczny dla zalogowanych] He stated that emergency and urgent care are different, so that [link widoczny dla zalogowanych] a [link widoczny dla zalogowanych] twenty-four hour [link widoczny dla zalogowanych] response time isn't necessary. He also wanted to be able to give a verbal rather than a written response to non-English speakers due to difficulties with translation.
Compliance with new health laws by July 1st may not be feasible. Problems have been encountered by insurers when they contract with other organizations that handle medical reviews.
Senior vice president of AHIP, [link widoczny dla zalogowanych] Jeffery Gabardi, believes that any delay in implementing the rules will not penalize individuals, but instead, would allow more time for establishing an appeals process that works for everyone without additional cost or complexity.
Appeals Rule Causes Face Off Between Insurers And Consumer GroupsArticle Summary: Insurers and consumers are squaring off over a provision of the new healthcare law, which involves independent reviews of coverage denials. Viewpoints are different on federal rules which cover the appeals [link widoczny dla zalogowanych] process.
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