Obama Plans Health Insurance Appeals


The White House administration announced new federal guidelines for individual and employer health insurance plans which will guarantee consumers the right to an appeal process with an outside neutral party.

The new rules will not take effect until next year because the insurance companies and President Obama’s guidelines is complex. The President is giving state insurance companies time to comply with the new guidelines.

While health insurance companies already have an appeal process in place, these guidelines are more consumer-friendly. If a medical claim is denied, the consumer appeals to the insurance company. If denied again, the consumer has the right to appeal to an outside source at the cost of the insurance company. The ruling of the outside source is binding and if the claim is founded, the insurance company has to pay the claim in full.


Assistant Labor Secretary Phyllis Borzi told reporters the appeals protections do not apply to health plans that were already in place at the time Obama signed the law and are considered "grandfathered." There will be additional guidelines forthcoming for the larger employers hire an insurance company to administer the coverage they pay for directly.

Some opponents of so-called “Obama-care” (the health insurance reform) have said that these guidelines will make health insurance less affordable. If the insurance company has to pay the cost of an outside appeal to a mediator, the costs will be past down to the consumer via increased premiums and the like. One such supporter who does not wish to be identified said, “And you can bet that each denial will come with an appeal just to stick it to the companies any way they can. They aren’t out for health care coverage, they’re mad because they’re poor.”

Supporters disagree, of course. There have been countless cases of denied health insurance that have led to preventable deaths across this nation. It is not the case that these individuals are poor and are out to “stick it” to anyone but that they just want what they feel is owed to them. “I think if I pay premiums for health insurance, I should have coverage, period. It’s what I paid for! If your job hands you a paycheck and then tells you your next job task, and you try and say to them, Sorry, task denied… what do you think they’d do? It shouldn’t work this way and I am glad the President is doing something about it,” says supporter, Tina*.
Either way, most Americans will see the new rules take place by July of 2011.

*name changed to protect identity.