New Affordable Care Act Regulations Give Patients The Right To Appeal Health Plan Decisions

(Published July 26, 2010)

          

New Affordable Care Act regulations have been issued by the Departments of Health and Human Services (HHS), Labor, and the Treasury, which empower consumers to appeal decisions made by their health plans or insurance companies. 

 

Consumers in new health plans in every state will have the right to appeal decisions, including claims denials and rescissions, made by their health plans.  This includes the right to appeal decisions made by a health plan through the plan's internal process and, for the first time, the right to appeal decisions made by a health plan to an outside, independent decision-maker, no matter what state a patient lives in or what type of health coverage they have.

 

In addition, grant applications from the $30 million Consumer Assistance Program are now available to help states and territories establish consumer assistance offices or strengthen existing ones.  The new funds will be used to provide consumers with the information they need to pick from a range of coverage options that best meets their needs, appeal decisions by plans to deny coverage of needed services, and select an available primary care provider of their choosing.