The Centers for Medicare & Medicaid Services (CMS) has released a new resource that describes:

The Affordable Care Act ensures a consumer’s right to appeal health insurance plan decisions, including asking that an issuer reconsider its decision to deny payment for a service or treatment, or to rescind coverage.

 

The Centers for Medicare & Medicaid Services (CMS) has released a new resource that describes:

• What issuer decisions can be appealed
• How long consumers have to initiate appeals
• How consumers must document and submit appeals
• How consumers can request an expedited appeal timeline in urgent care situations
• When and how to request an external review by state or federal authorities

These appeal rights and processes apply to consumers enrolled in non-grandfathered qualified health plans through a Health Insurance Marketplace.

 

Please see the “Internal Claims and Appeals and External Review Processes Overview” resource slides for more information. You can also link to these slides from the Agents and Brokers Resources webpage, which provides other resources to help you assist consumers in making use of their health coverage.