For Denied Claims, a Bit of Help in the Health Law

[groovedaddy]

Fighting with a health plan over a denied claim can leave people feeling they’ve been injured all over again.

The options for challenging an insurance company’s decision are limited. Appeals can be slow and cumbersome, if they are available at all, and most patients are barred from suing for damages resulting from denials and delayed treatments.

The new health law makes the system somewhat more consumer-friendly. Starting this fall, patients in all health plans can contest claim denials in an independent state-level review procedure — a recourse that has not generally been available to employees of companies that pay their employees’ health claims directly.

Since more than half of all covered workers are in a “self-funded” plan, the change is significant. “This fixes a long-standing problem,” said Sara Rosenbaum, head of the department of health policy at the George Washington University School of Public Health and Health Services. The provision does not apply, however, to “grandfathered” plans — those in existence on March 23, when the health law was enacted.

http://www.nytimes.com/2010/06/22/health/22land.html?th&emc=th

[Phoebe Loosinhouse]

1. An interesting but ultimately depressing article.

The words "a bit of help" are accurate.

[bemildred]

2. One could even say: "the pretense of help" and still be right on. nt

[Phoebe Loosinhouse]

3. Absolutely. nt

[supernova]

4. I signed on to my state's

HR pool site in hopes of signing up for the federal risk pool (how will I know the difference?)

I meet the qualifications for it.

We'll see.