Health plan appeals process
Section 2719 of the PPACA requires health plans to establish internal and external processes for beneficiaries to appeal decisions made by their health plan (e.g., a decision not to cover a particular treatment or pay the bill for a medical service already provided).
Federal Documents
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Federal regulations on private insurance market appeals process
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Interim final rules regarding internal claims and appeals as well as external review processes for group health plans.
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HHS fact sheet: Health plan appeals process
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An HHS fact sheet detailing the law and regulations that establish new avenues for consumers to appeal decisions made by their health plans.