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August 25, 2016 at 12:57 PM
A health policy specialist says state insurance regulators should think about updating their health plan complaint programs.
Betsy Imholz, a San Francisco-based special projects director at Consumers Union, is preparing to give a presentation on the topic Sunday, in San Diego, at the summer meeting of the National Association of Insurance Commissioners.
Imholz will be delivering the presentation together with Elizabeth Abbott, director of California’s Office of the Patient Advocate, at a session organized by NAIC’s consumer liaison committee.
The same session will feature presentations on bills for air ambulance services and the U.S. Department of Labor’s new fiduciary rule.
One of the original goals of the creators of the Patient Protection and Affordable Care Act of 2010, and of many earlier health system change efforts, was to help consumers appeal health plan claim denials.
Related: What if a health plan member hates a coverage decision?
But, in 2015, when Consumers Union surveyed consumers about experiences with “surprise medical bills,” the group found that 87 percent of privately insured U.S. adults did not know what government agency handles health coverage complaints, Imholz and Abbott say in their presentation slidedeck.
Seventy-three percent of the consumers surveyed did not know whether they had a right to appeal a claim denial to the state or to an independent expert, Imholz and Abbott say.
The speakers have also included 2014 complaint data for health insurance plans and managed care plans.
