Need to Make a Healthcare Appeal? Q&A from NAIRO Tells Consumers How

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NAIRO has published the primer, titled “Know your Healthcare Appeal Rights: A Q&A on the Health Insurance Appeals Process for Consumers,” to make it easier for consumers to understand the intricacies of pursuing internal or external healthcare appeals.

We are trying to help consumers understand their rights associated with the appeal process.

Consumers trying to sort out their appeal rights extended to them by last year’s healthcare legislation usually go away confused. The National Association of Independent Review Organizations (NAIRO) plans to change that. The trade group of independent review organizations has issued a question and answer primer to help healthcare consumers. Titled “Know your Healthcare Appeal Rights: A Q&A on the Health Insurance Appeals Process for Consumers,” NAIRO published the primer to make it easier for consumers to understand the intricacies of pursuing an internal or external healthcare appeal.

Explains Consumers Rights
“Legislators passed the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 to protect consumers and create more consistency for healthcare processes, especially the appeal procedures,” said Terri Giorgios, President of NAIRO. “However, the legislation does not make it easy for consumers to identify how to file an appeal when a health plan denies a treatment, procedure or service. With this Q&A, we are trying to help consumers understand their rights associated with the appeal process.”

Simple Question and Answer Format
Presented in a simple question and answer format, “Know Your Healthcare Appeal Rights” explains how to file a healthcare appeal for members of fully insured and self-funded health insurance plans. The Q&A covers several important points consumers will want to know:

  •     an overview of the appeal process
  •     the difference between internal and external appeals
  •     how to file internal and external appeals
  •     the role of states independent review organization (IRO) in deciding the outcome of an appeal

To further help consumers, the primer also contains a brief glossary of associated terms and a list of resources where they can seek further answers.

Free Download
Consumers and others interested in the healthcare appeal process can download “Know Your Healthcare Appeal Rights: A Q&A on the Health Insurance Appeals Process for Consumers” at http://nairo.org/_pdf/uploads/consumerappealsfaqnairo.pdf.

About NAIRO
NAIRO works to promote the value and integrity of the independent medical review process. Its 23 member organizations embrace an independent, evidence-based approach to medical review for resolving coverage disputes between enrollees and their health plans. For more information, visit http://www.nairo.org.

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MARTIN MIDDLEWOOD
FRONTLINE STRATEGIES INC.
(360) 882-1164
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