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Disputing insurance denials under health reform law

A community VOICE for Sylvania, about Sylvania
First November
Reprinted from the First November 2010 Issue of Sylvania AdVantage

Disputing insurance denials under health reform law Even though the enactment of the health care reform continues to be the source of considerable
debate and controversy, some of its provisions are being implemented this fall.

The legislation includes some significant consumer protections that all health care consumers should understand. In the past, patients and their doctors have
often been frustrated when health insurance companies refused to authorize services or procedures or denied payment after medical services were provided and medical bills incurred. One of the first provisions to go into effect changes the rules for denials of health services and payments by health insurance companies. The provision will make it easier for patients and their medical
providers to challenge managed care decisions.

Under the Affordable Health Care Act, often referred to as Obama Care, all health care plans must:

  • Provide consumers the right to internally appeal denials of payments or services.

  • Provide consumers an explanation of the internal appeals process when denying a payment or service.

  • Decide appeals promptly, 72 hours to sixty days depending on the urgency of care.

  • Provide an opportunity to appeal to an independent reviewer not employed by the health plan.

  • The plan must explain this process to the consumer.

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 detailed information, go to or the Ohio Department of Insurance

Thomas McArdle is a Sylvania resident, personal injury attorney and partner at
Cubbon and Associates a Toledo Law Firm providing legal services to injured persons.

Thomas McArdle

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