Insurance Companies Get Reprieve on Certain Administrative Rules, Consumer Groups Worry

The Obama administration is delaying [PDF] the implementation of certain rules under the new reform law that will enable protections for patients-consumers who wish to appeal claim denials or coverage reductions made by insurance companies. Originally, federal officials were supposed to start enforcement of rules which appear to benefit insurance companies, at least in the short term.

The Obama administration is delaying [PDF] the implementation of certain rules under the new reform law that will enable protections for patients-consumers who wish to appeal claim denials or coverage reductions made by insurance companies. Originally, federal officials were supposed to start enforcement of rules which appear to benefit insurance companies, at least in the short term.

Requirements that Insurance provide increased information outflow via translation to other languages for the benefit of non-English speaking consumers and reductions in the amount of time insurance companies must review denials in “urgent” cases are chief among the rules being delayed under reform.

Patient advocacy groups are scrambling to ensure these rules eventually see the light of day, while insurance companies look for more reasons to balk at administrative requirements by the federal government they see as carrying an increased cost to implement — citing issues [PDF] as mundane, yet labyrinthine, as diagnostic codes and patient surveys as administrative and logistical barriers too high to overcome in the timeframe required under ACA rollout.

Stalling tactic by Insurance to forestall patient protections before they’re even out of the gate? Or earnest re-evaluation of internal policies that requires more time to sort out cost concerns that insurance companies say they need in order to benefit consumers under reform?

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