Appealing Health Plan Decisions

The Affordable Care Act — By VoiceWaves on January 6, 2013 5:01 pm

The Affordable Care Act ensures your right to appeal health insurance plan decisions–to ask that your plan reconsider its decision to deny payment for a service or treatment. New rules that apply to health plans created after March 23, 2010 spell out how your plan must handle your appeal (usually called an “internal appeal”). If your plan still denies payment after considering your appeal, the law permits you to have an independent review organization decide whether to uphold or overturn the plan’s decision. This final check is often referred to as an “external review.”