Fine Print in Health Care Law Allows Insurance Companies to Choose Who Examines Their Disputed Decisions

Monday, September 12, 2011
Consumer advocates are complaining about a provision in the federal healthcare reform law that was supposed to give patients more power in disputes with insurance companies.
With insurers often refusing to pay for certain medical services, the legislation was drafted to include external reviews so patients had a way to appeal denials in coverage. But in implementing the mammoth new law, the Department of Health and Human Services has created regulations that allow insurance companies to choose the external reviewer—which makes the provision decidedly more business friendly, consumer watchdogs say.
“Advocates who have dealt with the external review process believe that it’s pretty clear that if [a reviewer] is being chosen by an employer (or insurer) it’s not independent,” Timothy Jost, a professor at Washington and Lee University School of Law, told Kaiser Health News.
Siding with insurers rather than patients, the Obama administration also changed the rules to prevent patients from appealing contractual disputes, such as a particular service or medication is covered in a policy.
A spokeswoman for the Department of Health and Human Services said the administration is simply trying to “ensure a balanced approach” in putting the new law into effect.
-Noel Brinkerhoff
Consumer Advocates Fear Health Law Will Favor Business (by Mary Agnes Carey and Marilyn Serafini, Kaiser Health News)


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