New regulations to empower consumers to appeal decisions made by their health plans or insurance companies were announced by the Department of Health and Human Services (HHS). The rules would also provide resources to help consumers take control of their healthcare decisions, and would help protect consumers from insurance company abuses. HHS made the changes in cooperation with the Departments of Labor and Treasury.
Now, consumers in new health plans in all states may appeal health plan decisions, including denial of claims. Appeals may be made to an outside, independent decision maker. The government has also made grants available to help states establish consumer assistance offices.
“The Affordable Care Act puts patients in control of their health care,” said HHS Secretary Kathleen Sebelius. “Today, if your health plan tells you it won’t cover a treatment your doctor recommends, or it refused to pay the bill for your child’s last trip to the emergency room, you may not know where to turn.” She says the changes provide new rights and resources to ensure that citizens get needed care.
Additional information, including fact sheets, is available at healthcare.gov.