This may be of interest to some who get denied for IVIG

[momto2pandas]

Leading the News

Administration Announces New Rules For Consumers To Appeal Health Claim Denials.

USA Today (7/23, Young) reports, "Consumers will get new and expanded rights to appeal denials of health insurance claims under federal regulations released Thursday." These "rules, part of the nation's new healthcare law, will make it easier for consumers to dispute an insurer's decision within the plan and require coverage to continue during the appeal, said Phyllis Borzi, an assistant secretary in the Department of Labor." Meanwhile, HHS announced on Thursday "a $30 million grant program for states to create or strengthen programs that help consumers find insurance and challenge claims denials." Jay Angoff, director of HHS' Office of Consumer Information and Insurance Oversight, "said the rules and grants will help end 'some of the worst' insurer abuses: 'For too long, consumers have been forced to fend for themselves.'"

Yet, "because health insurance and President Barack Obama's overhaul law are both complicated, the new federal safeguards will not immediately apply to most Americans with private coverage," the AP (7/23) reports, explaining that "first, consumers will appeal directly to the insurer. If they're denied a second time, they can go to an independent reviewer whose decision is binding." Notably, "health plans must pay the cost of outside appeals, and if they're overruled, they must cover the disputed claim in full." Consumers also have the right to appeal "if their coverage gets canceled."

The Los Angeles Times (7/23, Levey) reports, "For many Americans, few experiences with the healthcare system are more frustrating than a rejected claim from an insurance plan. Rejection notices are often unclear, as are the procedures for challenging them." The new rules are "designed to simplify the process and expand consumers' rights," though "it's difficult to say" whether the rules will "make a difference." Still, "many consumer advocates -- including Consumers Union, Families USA, the National Partnership for Women and Families and the AARP -- believe they provide important new protections."

The Hill (7/23, Lillis) reports that though they "won't apply to 'grandfathered' insurance plans -- those existing when healthcare reform became law in March -- the administration estimates the program will benefit 41 million Americans next year and 88 million in 2013."