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Some Cancer Patients and Survivors Still Vulnerable Under New Regulation on External Appeals
June 22, 2011
Washington, D.C. – June 22, 2011 – The administration today issued further guidance on an Affordable Care Act regulation that gives consumers the right to an external appeal if an insurance claim is denied. While the regulation makes strides in providing some clarification for consumers to resolve disputes with their health plan, the American Cancer Society Cancer Action Network (ACS CAN) has significant concerns about barriers to appeals that continue to exist.
A statement from Stephen Finan, ACS CAN senior policy director, on the regulation issued today follows:
“The Affordable Care Act took historic steps to eliminate red tape and empower patients with information to appeal denied medical claims. But this regulation does not adequately fulfill the intent of the law and denies consumers the tools they need to engage in the process.
“Transparency and independence are critical to ensure that a fair and objective appeal is conducted. Unfortunately, there are numerous barriers and burdens placed on the consumer that could prevent a timely and objective resolution to a denial.
“In addition, the regulation’s requirement that external appeals be limited to denials based solely on ‘medical judgment’ would fail to address a significant proportion of denied claims based on other factors such as coding errors and failure to receive pre-authorization. Of further concern is the reduced timeframe to file an appeal and time delay for resolution.
“To make the process as user-friendly as possible, notification of a patient’s right to appeal should be readily available and easy to understand. The regulation does not go far enough to make this information readily accessible and comprehensible for consumers.
“Finally, while ACS CAN acknowledges that it will take time to fully implement many provisions of the Affordable Care Act, delaying enforcement of the patient’s right to an external appeal is disappointing and extends a barrier to speedy review for patients and survivors who need access to timely care.
“This regulation had the potential to immediately mitigate many issues between patients and insurers. Unfortunately, the regulation falls short of adequately empowering patients who believe they have been wrongly denied coverage. ACS CAN urges the administration to again revisit this regulation from the perspective of patients and consumers, who for too long have incurred financial hardship because of barriers to a proper appeals process.”
ACS CAN, the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society, supports evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem. ACS CAN works to encourage elected officials and candidates to make cancer a top national priority. ACS CAN gives ordinary people extraordinary power to fight cancer with the training and tools they need to make their voices heard. For more information, visit www.fightcancer.org.
FOR MORE INFORMATION, CONTACT:
Alissa Havens or Steven Weiss
American Cancer Society Cancer Action Network
Phone: (202) 661-5772 or (202) 661-5711
Email: [email protected] or [email protected]
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