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Health Care Reform:

Health Insurance & Affordable Care Act

Health Care Reform and Settling Grievances: FAQ

Answers to common questions about handling grievances with your health insurance company.

Q: Is that appeal process already available? If not, when does it take effect?

A: For many people, internal and external appeals processes are already available. If your health plan went into effect on or after March 23, 2010, your insurer must comply with these laws as of Sept. 23, 2010.

If you have a plan that was in place prior to March 23, 2010, however, it may qualify for grandfathered status and the new guidelines for appeals may not apply. You can learn more about grandfathered health plans and what it means for you at the web site of Families USA, a nonprofit advocacy organization.

However, even if you have a grandfathered health plan, you should check with your insurer and/or state department of insurance about your right to appeal. Most states -- 44 -- already offer an external appeal process, although the laws vary greatly. All health plans are encouraged to adopt the new regulations prior to July 1, 2011.

Q: If I have a grievance and I'm appealing my insurance company's decision, what do I do in the meantime?

A: Ask your insurance company to continue paying for your treatment until a determination on your appeal has been made.

If your request is refused, it’s a good idea to speak with the doctor or hospital treating you. Ask to arrange a payment plan or if collections can be put on hold until your appeals process is complete.

Q: If I don't pay a contested medical bill, will it ding my credit?

A: Yes. It’s important that you don’t ignore medical bills. Instead, work with your health care provider to arrange a payment plan so your bills are not sent to a collection agency, which providers can be quick do. That can damage your credit rating.

If your bill has already been sent to collections, speak with the collections agency and ask to pay the bill right away. But don’t send a penny until you get the agency to agree to remove the bill from your credit report.

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