Monday, July 26, 2010

When Denial isn't just a river...

So you've had that emergency earectomy, and you're relieved that the bulk of the cost will be borne by your health insurer. How disheartening, then, when the EOB (Explanation of Benefits) arrives, and you learn that the claim has been denied.

What now?

Most states require carriers to not only justify a claims denial, but guarantee the insured the right to an external appeals process (Alabama, Mississippi, Nebraska, North and South Dakota do not guarantee the latter). And so-called ERISA (self-insured) plans don't have this requirement, either.

But that's about to change:

Beginning September 23rd, new ObamaCare© rules come into effect that require "the right to appeal denials directly to their insurers, and if necessary, to external review boards." Frankly, the only really new thing here is that this blanket requirement will apply to the four aforementioned states, and self-funded plans.

And, of course, there's a nice little carrot attached: "$30 million in grants to states to establish or strengthen consumer assistance offices." That's about $600 thousand per state (or, in Obamington, about $526,000 for each of the 57 states). Your tax dollars hard at work.

One thing I found quite interesting, though, is the fact that this legislation seems to explicitly exempt the most egregious claims denier of all: Medicare.

Wonder why.

[Hat Tip: FoIB Holly R and NAMI]
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