It's not the first time that insurers and consumer groups have battled it out, but the recent face-off over PPACA's provision allowing consumers to appeal coverage denials looks to be a big one.
New federal law gives this right to most consumers with individual and group-sponsored health coverage , so long as the plan was put into place after the law's adoption last July. (Plans with grandfathered status do not qualify.) In this new environment, consumers can seek outside review of an insurer's decision to deny, reduce, or cancel coverage. Also included within the provision was a mandate that insurers explain the reasons for their decision in their communication with a consumer.
Insurers have until July 1st to begin complying with the new regulation, and have also been invited to comment on the law. They have responded with a number of revision requests, chief among them increasing the new 24-hour deadline for reviewing urgent coverage requests. Other petitioned points include minimizing consumers' opportunities to seek review from external review boards and doing away with the requirement that information about the process be communicated to non-English speaking clients only in writing.
Insurers state that these requests will strengthen the effectiveness of the law, noting specifically that urgent care is different and often less time-sensitive then emergency care, and that non-English speakers may miss information in writing that they would understand if speaking with someone in their own language.
Twenty-four consumer advocate groups banded together in rebuttal earlier this week, objecting that insurer revisions may weaken the law or push back the implementation date.
"We are concerned that there is going to be a delay in implementation or a push back to weaken the final rules," Cheryl Fish-Parcham, deputy policy director at Families USA, a health advocacy group, told Kaiser Health News. "These rules offer crucial protection to people who are denied medical services, and who, in the past, had no other recourse."
Specific concerns were outlined in a letter to Karen Pollitz, director of Office of Consumer Support at the Department of Health and Human Services, and Phyllis Borzi, assistant secretary of the Employee Benefits Security Administration at the Department of Labor, which is currently being reviewed.
Regardless of how insurer requests may impact these new consumer protections, it certainly does seem as though the implementation date will be pushed back. Robert Zirkelbach, a spokesperson for America's Health Insurance Plans, said it may be impossible for insurers to comply by July 1st due to the time-consuming nature of the changes.
However, AHIP assures its opponents that any delays will not have a negative impact on the consumer. In a letter last fall to federal officials regarding this ruling, AHIP's senior vice president Jeffrey Gabardi wrote, "A delay in the compliance date to allow changes to the rules will not penalize individuals who are challenging claim denials. Rather, it will give everyone more time to 'get it right' in terms of establishing an appeals process that works for consumers, but does not add additional cost or complexity."
[Source: Kaiser Health News]
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