Affordable Care Act (Health Care Reform) Essay

1837 Words Jan 7th, 2012 8 Pages
Legal Methods and Process

The Affordable Care Act ensures your right to appeal health insurance plan decisions which is when you ask that your plan to reconsider its decision to deny payment for a service or treatment. New rules that apply to health plans created after March 23, 2010 spell out how your plan must handle your appeal (usually called an “internal appeal”). If your plan still denies payment after considering your appeal, the law permits you to have an independent review organization decide whether to uphold or overturn the plan’s decision. This final check is often referred to as an “external review.” Many states offer help to consumers with health insurance problems. The Affordable Care Act improves these
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After Joe takes all the steps to insure he has done everything possible to obtain insurance, because he has been denied, he can take his case to an attorney (or represent himself) in Court. All of the steps Joe must take have time limitations that must be adhered to, or he risks losing his right to continue to the next step of his claim. Before filing suit Joe must pursue an internal appeal. The internal appeal is required by Federal law so if Joe does not pursue this, he cannot file a lawsuit. The insurance companies are required by law to have an appeal process, so they do. However, there is very little detriment to an insurance company to deny an appeal because most people do not look for attorneys, and most people do not sue. Even when suits are filed the courts often give deference to the insurance company’s decision, so the disability claimant is faced with a significant challenge. Because Joe’s appeal has already been denied he can now file a lawsuit. First he must file a complaint against the Plan and/or the insurance company. The complaint will seek a declaratory judgment to require the defendant to pay or reinstate benefits, pay back benefits (with interest), and pay attorney’s fees incurred prosecuting the suit. Under Federal law Joe will not be entitled to recover any other amounts such as for pain and

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