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

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  • Ask the health plan the specific reason for the policy rescission.
  • Carefully read the insurance policy and make a list of questions about the rescission.
  • Review the providers’ policy handbook to find the process time allotted for a rescission appeal request and confirm this with the health plan.
  • Contact the state insurance commissioner to answer any questions needed to start an external review.
  • Meet all external review related deadlines and ask questions along the way.
  • Keep copies of correspondence, phone calls, documentation and medical records regarding the rescission review request.

Delivering Unbiased Determinations

As a best practice, many health plans are now enlisting IROs to review rescissions on a case-by-case basis using standardized guidelines and expert review of the medical facts.
“IRO objectivity is the reason state legislators in 45 states and the District of Columbia have mandated the independent review of healthcare appeals,” Ferris said. “Using an independent and unbiased third-party to review rescission is a best practice that preserves the quality and integrity of our healthcare system and the rescission process.”

About NAIRO

NAIRO works to promote the value and integrity of the independent medical review process. Its members embrace an independent, evidence-based approach to medical review to resolve coverage disputes between enrollees and their health plans. For more information, visit www.nairo.org.

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