Employees Can Now Request a “Federal External Review” On Health Claims

New health care reform regulations clarify how health care plans must handle disputed claims. The law now mandates that employees in self-funded plans can request a “federal external review” after their request for coverage of a claim or benefit is denied through internal reviews conducted by employers and plan administrators.

Does this mean that after the normal course of claim appeals governed by ERISA, the insured can then request additional review/s through a government agency? And how long will this extend the contestation period? Two, three, four years down the road? How are stop loss carriers going to handle this additional risk? The current “short tail” could now be a long one.

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