According to a recent article published in the New York Times (“For Denied Claims, a Bit of Help Under New Law”), patients may have more latitude in appealing to insurance companies when their medical claims are denied.
“The new health law makes the system somewhat more consumer-friendly. Starting this fall, patients in all health plans can contest claim denials in an independent state-level review procedure — a recourse that has not generally been available to employees of companies that pay their employees’ health claims directly,” writes Michelle Andrews.
The new law also provides for expedited review, within 45 days of the insurance carrier receiving a consumer’s request for review.
Unfortunately, the new law does not apply to plans already in existence as of March 23, 2010, nor does it equip consumers to sue carriers for pain and suffering resulting from the lack of treatment.
The appeals process as it currently operates can be especially costly for the consumer, though as the article states, consumer advocates are calling upon the government to relieve some of this financial burden.
Remember that a good way to avoid denied claims is to choose an insurance policy appropriate for your healthcare needs. Be familiar with what your plan covers, and you’re less likely to wind up trudging through a messy appeals process.
For more information about appealing a denial, see change:healthcare’s field guide, “How to Handle a Denied Medical Claim.”
SOURCE: NYT, (The New Landscape)
http://www.nytimes.com/2010/06/22/health/22land.html