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Doug Landau
Doug Landau
Attorney • (866) 735-1102 Ext 610

Fighting Health Insurance Care Denials

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A "DENIAL" by a health insurance company used to be the final word on treatment for many American families. However, it’s a new day for American consumers; the Affordable Care Act enlarges the rights of insureds to appeal denials. These rights include the right to an independent, external review board. This appeal process can also be used when health insurance coverage is cancelled. I would encourage all readers to avail themselves of this new law if they or a loved one have received a denial of needed medical care from their health insurance plan. With medical breakthoughs in the treatment of spinal cord injuries and diseases, it is heartbreaking discover that the care recommended by your own doctor has been "second guessed" and denied by some health insurance representative.

The Affordable Care Act is a comprehensive health care reform law that was enacted in March 2010. Insurance companies will not be able to deny claims without a chance for appeal. In new health plans, you now have the right to demand that your health plan reconsider a decision to deny payment for a test or treatment. That also includes an external appeal to an independent reviewer. The regulations will apply to new health insurance plans starting September 23, 2010. "Until the [Federal health care law] reform, only a select number of states honored external review," says Erin Moaratty, a spokesperson with the Hampton Virginia nonprofit Patient Advocate Foundation.

Patient Advocate Foundation’s Patient Services provides patients with arbitration, mediation and negotiation to settle issues with access to care, medical debt, and job retention related to their illness. According to Moaratty, "Now every state is required have a process for external appeals." Review boards have reversed about 45% of appealed denials, according to my friend Candy Sagon’s excellent article in the September, 2010 AARP Bulletin.