A Kaiser Health news story noted “Federal rules ensure that none of the millions of people who signed up for Obamacare can be denied insurance — but there is no guarantee that all health services will be covered.”
“A 2011 GAO report sampling data from a handful of states before the health law took effect found that patients were successful 39 to 59 percent of the time when they appealed directly to the insurer. When appealing to a third party (such as the state insurance commissioner), patients also were often successful in getting the service in question – winning as many as 54 percent of such decisions in Maryland, for example. ”
“It’s often very worthwhile for a consumer to appeal…,” “It’s a really important protection for people.” “Until a few years ago … the rules regarding such appeals varied by state and employer.” “Insurers often get it wrong the first time…,” “So if you’ve been denied a health care service, it might be because the plan didn’t understand why that service was needed and why it fit their guidelines.” “Many consumers … are not exercising their appeal rights as much as they should.”
Click here to read the full KHN article “Patients Often Win If They Appeal A Denied Health Claim” By Pauline Bartolone.
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Doctor, Did You Wash Your Hands? ™ provides information to consumers on understanding, managing and navigating health care options.
Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration.
This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.