Wednesday, June 8, 2016

Health Insurance Appeals Rights and Processes

  • From the Centers for Medicare and Medicaid Services (CMS): Internal Claims and Appeals and External Review Processes Overview is a set of slides providing information about a consumer's right to appeal health insurance plan decisions under the Affordable Care Act, including the right to ask that an issuer reconsider its decision to deny payment for a service or treatment, or to rescind coverage. The slides describe:
    • What issuer decisions can be appealed
    • How long consumers have to initiate appeals
    • How consumers must document and submit appeals
    • How consumers can request an expedited appeal timeline in urgent care situations
    • When and how to request an external review by state or federal authorities
These appeal rights and processes apply to consumers enrolled in non-grandfathered qualified health plans through a Health Insurance Marketplace. 

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