PPACA: Independent Denial Reviewers Call for Changes

Regulators should make the health plan decision appeals process more independent, according to a group that represents independent review organizations.

The National Association of Independent Review Organizations, Westerville, Ohio, says the Affordable Care Act – the federal legislative package that includes the Patient Protection and Affordable Care Act (PPACA) – includes a provision that will require health plans to impose effective internal and external appeal processes when they deny coverage for medical procedures.

But health plans still can use their own doctors to conduct the first level of appeals, and they often can use their own doctors to conduct the second level of appeals, according to NAIRO.