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Life Health > Health Insurance > Health Insurance

Lawmakers complain about exchange appeals

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Republican leaders of the House Energy and Commerce Committee have written to the U.S. Department of Health and Human Services to complain about reports of problems with the federal exchange appeals system.

The Patient Protection and Affordable Care Act is supposed to give users of the new federal and HHS-run health insurance exchanges the right to appeal denials of access to premium tax credits.

Users also are supposed to be able to appeal denials of applications for help with covering out-of-pocket costs.

Exchanges are supposed to notify users of benefit denials, and users are supposed to be able to file appeals through the exchange website.

House Energy leaders told HHS they were disturbed by a Washington Post article suggesting that tens of thousands of people may be stuck in the plan application pipeline because HHS has failed to tell them about application problems or benefits denials.

The exchange enrollment website lacks a working appeals process, lawmakers add. 

“Individuals who wish to make an appeal over their coverage to the administration can do so only via mail,” lawmakers write.

Rep. Fred Upton, R-Mich., the committee chairman, and other Republican committee leaders have asked HHS to write to them by Feb. 21 about the number of people affected by the apparent breakdown in the appeals system, the types of mistakes involved, and the process for handling appeals by mail.

The lawmakers also are asking HHS Secretary Kathleen Sebelius to send them documents about the PPACA appeals process and the status of the computer systems supporting the appeals process.

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