Govt sets consumer rights in health care disputes

AP News
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Posted: Jun 22, 2011 4:26 PM
Govt sets consumer rights in health care disputes

The Obama administration says most Americans will soon have the right to appeal to a third party referee when their health insurer denies a claim for a medical service.

The rules released Wednesday carry out provisions of President Barack Obama's health care law. Insurers generally give customers a couple of chances to appeal internally, but access to outside review varies.

Consumer groups say it's a move in the right direction, just not far enough. For example, advocates wanted 24-hour turnaround in cases involving urgent care, and the rules allow up to 72 hours.

The rules take effect in January, except for "grandfathered" plans. Only a small percentage of denials are ever challenged.

A recent study of a sample of claims found insurers reversed their initial decisions half the time.