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Friday, October 14, 2011 - 7:50am

Third Look For Insurance Rejections

A federal agency says Georgia, along with a dozen other states, falls short in offering consumers appeal options when they can’t get health insurance. The states must make fixes by January 1st.

The national health reform law calls for a broader range of appeals options for people who can’t get coverage or payment on a claim. That means more consumers for the first time will have the right to have an independent panel review their case.

Currently in Georgia, customers can appeal a decision to the health plan itself. The state’s review process only involves appeals for health-plans not run by self-insured employers.

Cindy Zeldin with advocacy group Georgians for a Healthy Future says the new federal law adds consumer protections:

“No restrictions on the minimum amount of the claim that you filed. That the external reviewer has to be randomly assigned and not have a conflict of interest.”

An official with Georgia’s Insurance office says the state must either contract with three independent review organizations, or ask the federal Health and Human Services to handle appeals.

Health insurers would shoulder the cost of the reviews.

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