Do Americans already have the right to appeal if a health plan denies coverage for something?
Many do, but rules differ depending on whether you get insurance from an employer or buy it on your own. Consumer protections also vary dramatically from state to state. Existing federal rules require most employer-provided plans to have an internal process for appealing a rejected claim. But if you lose, there is no guarantee that you can take your appeal to an independent third-party reviewer. You currently have no right to an external review of your denied claim if you work for a company that self-insures, as many large employers do. And if you buy insurance on your own, you may not get an external review either. Thirteen states guarantee an external review for only some kinds of health plans. Six states do not require any independent review process. So what happens now? The new rules essentially standardize the process for internal and external appeals. Next year, if you qualify for the new protections, you will be guaranteed an internal review if your claim is denied, whether you
Related Questions
- Am I Eligible For An External Appeal If My Health Plan Denies Coverage Because I Have A Pre-Existing Condition Or Because I Exhausted a Benefit Under My Health Insurance Contract?
- My spouse has health benefit coverage under her employer. Can I deduct the eligible expenses that are not covered by her plan under my PHSP?
- How can I file an appeal if my former employer’s group health plan denies my application for the premium subsidy?
