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Archived News Release Caution: Information may be out of date. |
Release Date: 11/20/2000
Release Number: 01-6
Contact Name: Gloria Della
Phone Number: 202.693.8666 |
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New rules announced today by the U.S. Department of
Labor will ensure workers quick processing of health insurance claims
and timely decisions on appeals when claims are denied. The rules cover
health plans offered by employers and covered by the Employee Retirement
Income Security Act, known as ERISA. |
“More than 130 million people in employer-based
health plans will be able to count on a faster, fairer and more informed
process for handling their claims and appeals to pay benefits,”
Secretary of Labor Alexis M. Herman said. “This final rule was
directed by President Clinton and is based on recommendations from the
President’s Advisory Commission on Consumer Protection and Quality in
Health Care, which called for better disclosure of information about
health benefits and a fair and efficient system for resolving disputed
claims for health benefits.” |
The final rule will be published in tomorrow’s
Federal Register. It is the first change in rules governing the claims
and appeals process in 20 years. The Labor Department published proposed
claims procedures in September 1998 and held a hearing on the proposal
in February 1999. |
The new rule covering ERISA-governed health plans:
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Requires timely coverage and
appeal decisions
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Provides meaningful information to
patients about their rights under the appeals process
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Creates a more fair process to
review decisions to deny benefits
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The final rule provides for:
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Faster decisions on initial claims
and appealed claims, with time frames based on whether the claims
are pre-service and post-service
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Special rules requiring
expeditious consideration of claims involving urgent care
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More time for patients to appeal
denied health claims
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Different decision maker to handle
appeals; consultation with relevant health care professionals in
making decisions about appeals that involve medical judgment
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Enforcement of claimants rights
through the court
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Timely action on concurrent care
reviews for patients receiving a course of treatment who face early
termination of benefits or have a need to extend treatment
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Fuller disclosure, including a
full decision of the plan’s claim procedures
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More information about the reasons
for a denied claim and the criteria and rules applied by the plan
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In addition, the department will publish tomorrow
final amendments to its regulation governing the contents of summary
plan descriptions to update and clarify specifically what information
must be disclosed to workers and their families about their health
plans. The final rule also covers plan descriptions that affect both
pension and welfare benefit plans. It further adopts in final form
regulations that were effective on an interim basis implementing certain
amendments to ERISA’s disclosure rules that were enacted as part of
the Health Insurance Portability and Accountability Act and the
Newborns’ and Mothers’ Health Protection Act. |
U.S.
Department of Labor news releases are accessible on the Internet. The information in this news release will be made
available in alternate format upon request (large print, Braille, audio
tape or disc) from the Central Office for Assistive Services and
Technology. Please specify which news release
when placing your request. Call 202.693.7773 or TTY 202.693.7775. |