In other health reform news, the Department of Health and Human Services has announced new regulations for consumers to be able to appeal decisions made by their health plans or insurance companies, as well as the availability of resources to help consumers gain more control of health care decisions.

The regulations provide for an internal appeals process whereby consumers may present information their health plan might not have been aware of, and possibly clear up misunderstandings. New health plans must have an internal appeals process beginning on or after September 23 that: a. allows consumers to appeal when a health plan denies a claim for a covered service or rescinds coverage; b. gives consumers detailed information about the grounds for the denial; c. requires plans to notify consumers about their right to appeal and instructs them on how to begin an appeal; d. ensures a full and fair review of the denial and; e. provides consumers with an expedited appeals process in urgent cases.


If an internal appeal is denied, consumers in new plans will have the right to appeal denied claims to an independent reviewer--one not employed by the health plan.

A Consumer Assistance Grants program will be initiated to offer nearly $30 million in new resources for states' efforts to establish or strengthen consumer assistance programs. All states and territories may apply for the grants. The consumer assistance can include: helping consumers enroll in health coverage; helping consumers file complaints and appeals against health plans; educating consumers about their rights; and tracking consumer complaints to help identify problems and strengthen enforcement.

More on the regulations and grants program can be found here.

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