Obama Administration delays rules for appealing patient payment denials

The Obama Administration is postponing until January 2012 rules intended to help patients appeal denials of care from their insurers, reports Kaiser Health News

The delay has put some consumer groups on edge, as some say the Obama Administration is is under pressure from insurers to make more payer-friendly changes. 

"We want to be sure that delays don't mean it won't happen," said Cheryl Fish-Parcham, deputy director for health policy at Families USA. Patient appeals are often decided in favor of the patient. Consider that consumers in New York state won 47 percent of appeals in 2009.

The rules were part of the Patient Protection and Affordable Care Act, which was signed into law in March 2010. Among the stipulations are that insurers must: 

  • review a denial of coverage in an urgent case within 24 hours--compared to the current 72-hour requirement
  • provide specific information about the denial to the patient, including diagnostic codes, and why the treatments are not being covered
  • inform patients about how to appeal, in language aimed at non-English speakers

The rules were originally intended to go into effect in January of this year. They were initially delayed until July 2011 before the most recent delay until next January. A posting on the Department of Labor website said the rules would likely be changed

In announcing the delay--some say quietly--the Labor Department on March 18 said it is "working with employer plan sponsors, health insurance issuers, States, and other stakeholders" to help them comply and that it will release the long-anticipated rules "in the near future."

For more information:
- read the Kaiser Health News article
- read the DOL's announcement

Related Articles:
GAO: Many claim denials are reversed on appeal  
Internal and external appeals: Health plans face quick turnaround in urgent cases  
NY Consumers won 47 percent of appeals in 2009