The White House announced new regulations giving consumers avenues to challenge decisions made by their health plans, delivering on one of several provisions of the Patient Protection and Affordable Care Act aimed at reining in what the Obama administration has characterized as a pattern of bad behavior in the industry.
New rules let consumers challenge insurers
The regulations, jointly issued by HHS, and the U.S. Labor and Treasury departments, give enrollees in new health plans the right to appeal such actions as rescissions and claims denials through a standardized internal process and also to an independent reviewer.
The regulations encourage states, 44 of which currently provide for some level of external review, to adopt procedures in line with a model law crafted by the National Association of Insurance Commissioners. A federal review will be available to consumers living in a state that doesn't offer consumers such a process or one that's deemed inadequate.
The rules apply to any new group or individual plan beginning after September; grandfathered plans are excluded, though many may be subject to appeals requirements of their state insurance departments. The Treasury Department estimates about 40 million consumers will benefit in 2011.
HHS also announced a $30 million grant program available to help states establish or improve programs that help consumers navigate their coverage options.
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.