HCFANY commends the development of regulations that provide strong consumer protections relating to internal claims, appeals, and external review processes under the Patient Protection and Affordable Care Act (PPACA). However, we also recommend ways in which the rules could be made clearer or stronger in the following areas: adverse benefit determination, notice and information issues, qualifications of reviewers, standards of reviews, language and literacy tests, informing consumers about their right to consumer assistance and advocacy; legal remedies; and the minimum standards for consumer protection in the NAIC model act.

Downloads

• HCFANY Comments on Insurance Appeals and External Reviews under PPACA