What is the appeals and grievance process like?
What specific appeals and grievance procedures apply, and the extent and nature of legal remedies available, vary significantly from state to state, company to company, and often depend upon whether the health insurance or plan is or is not one covered by the Employee Retirement Income Security Act of 1974 (ERISA), as amended by the Multiple Employer Pension Protection Act of 1980 (MEPPA), typically collectively referred to as ERISA. The original noble idea behind this federal law was protection of employee benefits and pension moneys from mismanagement or theft by incompetent or greedy trustees or by organized crime. Unfortunately, except for state laws that actually regulate insurance companies or health plans, ERISA also preempts (eliminates) any state law or remedy for insured or plan members that might otherwise relate to the administration of employee benefits, including health care insurance benefits, obtained through employment. In other words, as a practical matter, if a claim
