Kaiser Health Newshttp://www.kaiserhealthnews.org/Stories/2011/June/22/External-Appeals-Reg-Jaffe.aspxThe Obama administration announced Wednesday that it is scaling back some of its earlier rules under the 2010 health law that governed consumers' right to appeal denials by health plans, disappointing patient advocates and earning praise from industry groups.The health overhaul gives members in group and individual health plans the right ? many for the first time -- to appeal the denial of coverage to an independent review panel. But the administration's new rules provide beneficiaries less time to prepare their appeal, less information about why their claim was denied and limit what type of denials can be challenged.
A spokesman for America's Health Insurance Plans, which had pressed the administration for changes, said the trade group was still reviewing the 95-page document, but the group's overall impression was positive.
"The new regulations take important steps to simplify and streamline the appeals process so that patients can receive the most accurate and timely decision about their medical claims," said the spokesman, Robert Zirkelbach.
Stephen Finan, senior policy director at the American Cancer Society Cancer Action Network, said Wednesday's announcement would have the opposite effect. "Transparency and independence are critical to ensure that a fair and objective appeal is conducted," he said. "Unfortunately, there are numerous barriers and burdens placed on the consumer that could prevent a timely and objective resolution to a denial."
Comment by Don McCanne of PNHP: Was reform intended to benefit patients or insurers? As the reform process evolved, the insurers were dictating the policies. Understandably, they took care of their own interests first. Their lack of concern for patients is confirmed by the fact that their policies will leave 23 million people without any coverage and tens of millions more with inadequate coverage.
Officials of the Obama administration, along with leaders in Congress, were complicit with the insurers during the legislative process that led to the Affordable Care Act. You might think that they would show some remorse by tailoring the provisions of the act to better benefit patients. No.
The example of the rule change for determinations involving urgent care shows where their heart is. If a patient requires urgent care, the system should be designed to ensure that the necessary care is provided immediately. Yet read the contorted explanation leading to the revised rule above. It is being revised to ensure that the insurers are allowed three days instead of one to make a decision. That might even save them money should the patient die in the interim.
The administration's rule: first do no harm - to the insurance company. And the patients? Who's making these rules anyway? The patients need to butt out.What would be the appeals process for a determination of urgent care under a single payer national health program? Appeals? What are you talking about? If the patient urgently needs care, the patient gets care - now! Period.
My comment: In countries like Japan, Germany and France, which work with private insurance to obtain truly universal coverage,
claims denial is flat out Illegal!
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