government

HHS limits health plan appeals process

NEWS IN BRIEF — Posted July 4, 2011

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Consumers will have less time to appeal coverage denials by their health insurers, but states will have more time to establish external appeals processes, according to an interim final rule published June 24 by the Depts. of Health and Human Services, Treasury, and Labor along with the Internal Revenue Service. The health system reform law for the first time mandates a standardized external appeals process for health plan denials, including for self-insured plans.

The agencies adjusted certain deadlines in the amended rule. Health plans will have 60 days to finish an internal appeal instead of the original 45 days. Enrollees will have 60 days to appeal a coverage denial instead of 120 days. The agencies also gave health plans until Jan. 1, 2012, to comply with the rule -- an additional six months.

The regulations apply only to health plans created or significantly altered after Sept. 22, 2010. HHS estimates that this will apply to plans covering 78 million people by 2013. The departments are accepting comments on the rule until July 25, three days after it takes effect. The rule is available online (link).

Note: This item originally appeared at http://www.ama-assn.org/amednews/2011/07/04/gvbf0704.htm.

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