Internal Claims and Appeals and External Review Processes

In July, the government issued healthcare reform regulations on a participant's ability to appeal decisions made by a group health plan through the plan's internal process. The regulations and additional guidance released in August address the right to appeal such decisions to an outside, independent decision maker - an "Independent Review Organization," or IRO. Important changes standardize the internal and external process individuals can use to appeal decisions by health plans.

Click here to download Internal Claims and Appeals and External Review Processes.