Your rights as an insurance consumer: Some websites

[Guest guest]

Hello again,

Here is information my sister-in-law was kind enought to send me.., regarding

consumer-oriented resources for understanding our rights as insurance consumers

(U.S. only). There is a lot of info here, but please read through it. One of

these websites may provide those of you who feel unserved by your insurance

companies useful places to start learning about your rights and what the law

requires insurance companies to provide to us! Of couse, if any of you have

had experience using legal recourse to get action, share your insights here!

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(1) Claims and Appeals Information: As you may know, there are new rules that

were just implemented Jan. 1 of this year that create more extensive internal

claims and appeal protections for consumers of private, employer-sponsored

health plans - these are known as the Dept. of Labor Claims Procedure Rules.

Under these rules, consumers have a right to timely initial decisions on

coverage by the plan, and a right to a timely and fair appeal process to dispute

the plan's initial decision. More information about these rules can be found on

the DOL website(www.dol.gov/ebsa), but it is mostly either the rule itself

(http://www.dol.gov/dol/allcfr/ebsa/Title_29/Part_2560/29CFR2560.503-1.htm) or a

series of q&as that may be too complex for the average reader

(http://www.dol.gov/ebsa/FAQs/faq_claims_proc_reg.html) - either of these

documents are good resources for attorneys who represent patients, though.

The most consumer-friendly information they have on how to file a claim

(http://www.dol.gov/ebsa/Publications/how_to_file_claim.html) seems too basic

and leaves out many of the important details and timelines for the updated rule.

Thankfully, there are other resources that consumers can turn to for this

information. This past year, Consumers Union and Kaiser Family Foundation

published a very good guide to internal and external appeal rights for consumers

under state and federal law - it can be found at:

http://www.consumersunion.org/health/hmo-review/.

(2) Other Health Care Rights: Information on other federal rights, including

continuation of coverage rights under COBRA and protections against

discrimination, portability protections, mental health parity requirements,

newborns and mothers protections, and breast reconstructive surgery requirements

are all available from DOL on their website: www.dol.gov/ebsa. States also have

a number of important protections in place that will apply to all individuals

who have private insurance coverage licensed in the state - these protections

won't apply to individuals whose employer-sponsored coverage is " self-insured " :

consumers need to check with their employer for information on what type of plan

they have. For information on insurance protections, contact the state

insurance department - state department contact information can be found on the

National Association of Insurance Commissioners' website at www.naic.org.

(3) Consumer Assistance: Consumers who need assistance in understanding their

rights under federal and state law can also seek help from government agencies.

For help from DOL re: claims and appeal issues, COBRA, HIPAA, and other

protections, consumers can call DOL's toll free number: 1., or their

regional DOL office - number on DOL website (www.dol.gov) or in yellow pages

under federal listings. For help on state insurance requirements, consumers can

contact their state department of insurance or health, depending on which one

administers those laws in the state - for a listing of all state insurance

departments, check the National Association of Insurance Commissioners' website

at www.naic.org. There are also some state and local private and public

consumer assistance programs to help consumers understand the law as it relates

to private insurance - unfortunately, there are not so many right now, but there

is a national clearinghouse called the Health Assistance Partnership where

consumers can find them - the web link is:

http://www.healthassistancepartnership.org/site/PageServer?pagename=private_insu\

rance.

Katy Badt Frissora

MAGIC RSS Co-Division Consultant

Mother of , RSS, age 6

126 Lexington Avenue Fair Haven, NJ 07704

732 842.4419 FAX: 732 842.6673