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Health Plan Policy Rescission Won't Go Away, Says NAIRO
Date:2/24/2010

ssue is an unbiased independent rescission review process that meets both the needs of consumers and health plans,” said Seana Ferris, President of NAIRO.

AHIP Guidelines Support Third-party Reviews

America’s Health Insurance Plans (AHIP) and NAIRO support an unbiased approach to rescission review. Recently AHIP published rescission review guidelines calling for health plans to conduct an “objective and thorough investigation prior to initiating the rescission process” for any claim denied based on a pre-existing medical condition. The AHIP guidelines encourage regulators to screen rescissions to determine their eligibility for external review. They also advocate a third-party reviewer must be independent from both the health plan and the consumer to ensure fairness. The guidelines further suggest health plans create standards to ensure rescission review is consistently applied, and includes specific timeframes for completion and expediting reviews.

Consumer Options for Review

Many health plans are adopting the use of IROs to provide an objective review of a member’s appeal of a rescission determination. However, part of the burden of a rescission review remains on the policyholder. According to most health plans and the AHIP guidelines, consumers should first exhaust their plan’s internal appeal process before requesting a third-party review through their state’s insurance commissioner or office of consumer protection.

Consumers seeking to appeal their insurer’s decision to rescind their healthcare insurance have the right to an external appeal. Some of the steps they must take to request an external review include:

 

Source: PRWeb
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