State establishes new review for insurance denials
If you've had health care coverage denied by your insurance, there's now another way to appeal that decision. The state of Alaska has rolled out a new, external review process by which a nationally accredited, independent review organization will assess whether an insurer's denial is justified.
"It's a consumer protection, or consumer assistance program, that's what it is," Mike Navarre, commissioner of the Department of Commerce, Community and Economic Development said. "It's a process where the Division of Insurance will help consumers make sure they get a proper determination."
According to Navarre, prior to the Affordable Care Act, if insurance companies denied a claim for coverage, you'd have to file an appeal for review by the company itself which meant the same business ended up reviewing its own decisions.
The Affordable Care Act established an independent review process at the federal level. Now, the state is doing something similar by taking its own pick of review organizations to look at medical and dental claims both in the individual and group market.
"We had to go through a process where we had to ask the federal government for the ability to do our own external review process, we went through that process, we got the regs in place," Navarre said. "This allows it to be configured more closely to plans in Alaska to Alaska health care."
However, the new review process does not apply to federally funded insurance like Medicaid or Medicare or employer self-funded plans.
"Employer self-fund programs, almost all of them have an external review process, and that's something that the Division of Insurance can take a look at to make sure that it's adequate," Navarre explained. "For the federal programs, Medicaid, Medicare, things like that, those are already heavily regulated and have processes in place for consumer protection.'
More information on the review process can be found at externalreview.alaska.gov or by calling consumer services at (907) 269-7900 or 1-800-INSURAK for calls placed outside of Anchorage.
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