Employers have been given more time to comply with some of the new rules designed to protect patients who receive health insurance claims denials.
Plan sponsors now have until Jan. 1, 2012 to comply with certain healthcare claims and appeals rules established by the healthcare reform law.
The four requirements that have been pushed back to 2012:
- Health plan participants must be notified by their employer or plan administrator of a coverage determination (whether it’s a denial or not) in urgent care situations within 24 hours — a reduction of the previous 72-hour limit.
- Internal and external claims appeals and review notices must be provided to non-English speaking participants in a “culturally and linguistically appropriate manner.”
- When claims denial notices are issued, they must explain what treatments aren’t covered under the plan and why — complete with diagnostic codes used by doctors, hospitals and nurses.
- If a plan fails to adhere to all the claims and appeals requirements, the plan participant is permitted to seek the remedies available under ERISA or state law — including litigation.
Originally, the claims and appeals rules were to take effect for plan years beginning on or after Sept. 23, 2010.
The feds then pushed back enforcement until July, 1 2011.
The new enforcement grace period that pushes back compliance for the rules listed above until 2012 was put in place so the feds could review public comments about the rules. The Department of Labor (DOL) said it intends to use the comments to amend the rules — but gave no indication of what changes will be made.
Info: DOL’s Technical Release No. 2011-01
