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Obamacare

One of the first provisions of the Affordable Care Act, (f/k/a) Obama Care, to go into effect this fall changes the rules for denials of health services and payments by health insurance plans. The provision covers health insurance companies and self insuring employers.All health care plans must now provide consumers the right to internally appeal denials of payments or services.A health insurance company or self insuring employer must explain how to internally appeal a denial when it denies a payment or service.Internal Appeals must be decided promptly:
  • Urgent Care, 72 hours.
  • Non Urgent Care yet to be received, 30 days.
  • Non Urgent Care already received but denied, 60 days.
If the denial is upheld, a consumer may appeal to an independent reviewer not employed by the health plan. The plan must explain this process to the consumer.In the event of a denial of urgent care, the internal and independent review can occur simultaneously.Consumers are entitled to receive all appeals-related information in their native language.The new requirements apply to new health insurance plans created after March 23, 2010 and all annual renewals occurring after September 23, 2010.For more information, go to www.healthcare.gov or the Ohio Department of Insurance www.insurance.ohio.gov.

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