{"id":19260,"date":"2021-12-13T07:42:13","date_gmt":"2021-12-13T12:42:13","guid":{"rendered":"https:\/\/medicarereport.org\/?p=19260"},"modified":"2021-12-13T07:42:59","modified_gmt":"2021-12-13T12:42:59","slug":"consumer-appeal-rights-in-private-health-coverage","status":"publish","type":"post","link":"https:\/\/medicarereport.org\/?p=19260","title":{"rendered":"Consumer Appeal Rights in Private Health Coverage"},"content":{"rendered":"\n<p>(By Karen Pollitz for Kaiser Family Foundation published December 10, 2021)<\/p>\n\n\n\n<p>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\u00a0<a href=\"https:\/\/www.kff.org\/report-section\/ehbs-2020-section-10-plan-funding\/\">most<\/a>\u00a0privately insured Americans and which states cannot regulate.  Continue reading <a href=\"https:\/\/www.kff.org\/private-insurance\/issue-brief\/consumer-appeal-rights-in-private-health-coverage\/\" data-type=\"URL\" data-id=\"https:\/\/www.kff.org\/private-insurance\/issue-brief\/consumer-appeal-rights-in-private-health-coverage\/\">here&#8230;<\/a><\/p>\n\n\n\n<p class=\"has-text-align-center\"><img loading=\"lazy\" decoding=\"async\" width=\"275\" height=\"258\" class=\"wp-image-7499\" style=\"width: 275px;\" src=\"https:\/\/medicarereport.org\/wp-content\/uploads\/2017\/07\/Kaiser-Family-Foundation.jpg\" alt=\"\"><\/p>\n\n\n\n<pre class=\"wp-block-preformatted\"><strong>Notice:<\/strong> The link provided above connects readers to the full content of the posted article. The URL (internet address) for this link is valid on the posted date; medicarereport.org cannot guarantee the duration of the link\u2019s validity. Also, the opinions expressed in these postings are the viewpoints of the original source and are not explicitly endorsed by AMAC, Inc.; the AMAC Foundation, Inc.; or medicarereport.org<\/pre>\n","protected":false},"excerpt":{"rendered":"<p>(By Karen Pollitz for Kaiser Family Foundation published December 10, 2021) The Affordable Care Act (ACA) requires that all consumers<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,42],"tags":[],"class_list":["post-19260","post","type-post","status-publish","format-standard","hentry","category-affordable-care-act-aca","category-employer-healthcare"],"_links":{"self":[{"href":"https:\/\/medicarereport.org\/index.php?rest_route=\/wp\/v2\/posts\/19260","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicarereport.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicarereport.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicarereport.org\/index.php?rest_route=\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/medicarereport.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=19260"}],"version-history":[{"count":2,"href":"https:\/\/medicarereport.org\/index.php?rest_route=\/wp\/v2\/posts\/19260\/revisions"}],"predecessor-version":[{"id":19262,"href":"https:\/\/medicarereport.org\/index.php?rest_route=\/wp\/v2\/posts\/19260\/revisions\/19262"}],"wp:attachment":[{"href":"https:\/\/medicarereport.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=19260"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicarereport.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=19260"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicarereport.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=19260"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}