Consumer Appeal Rights in Private Health Coverage

(By Karen Pollitz for Kaiser Family Foundation published December 10, 2021)

The Affordable Care Act (ACA) requires that all consumers in non-grandfathered health plans have the right to appeal denied claims, first internally to the plan, and then, if the plan upholds its denial, to an independent external reviewer, sometimes called an IRO. Most states had enacted external appeal laws prior to the ACA, but these did not apply to self-insured group health plans which cover most privately insured Americans and which states cannot regulate. Continue reading here…

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