DOL/IRS issue amendments to IFR on claims appeals
Posted on June 22, 2011 | No Comments
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The US Department of Labor (DOL) and the Internal Revenue Service (IRS) have issued separate amendments to the July 23, 2010 Interim Final Rule (IFR) on internal claims and appeals and external review processes for group health plans and health insurance issuers offering coverage in the group and individual markets. The Employee Benefits Security Administration (EBSA) of the Department of Labor has also issued new guidance on the subject.
The IFR, recent amendments, and recent guidance do not apply to grandfathered plans.
August 23, 2010
The Department of Labor has issued a technical release on the rules concerning review of appeals for denied claims.
August 29, 2010
The right to a fair and impartial appeal when a group health plan or health insurer denies a claim would seem to be a basic matter of fairness. Historically, however, this has not been the case. Patient protections vary tremendously depending on the type of health insurance and federal and state legal requirements.
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