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Obamacare Appeal Rights and Process

Obamacare Appeal Rights and Process

Under the purview of the Patient Protection and Affordable Care law after its launching in the year 2010, it has become much easier to appeal against any kind of denial by any health or medical insurance service provider, marketplace decision or a SHOP decision. However, engaging yourself in a conflict with a health insurance service provider can aggravate at a certain point of time and maybe also time-consuming if your insurance provider chooses to deny service on certain treatments. And while dealing with an appeal for covering denial specific strategies should be undertaken in order to specifically fight with the issue. At times situation might take place when you are denied or get refused to pay a claim by your service provider. If you are denied of health insurance coverage by your medical care insurance service provider then being a customer or applicant you gather the right to appeal the decisions of your service provider and reviewing the same with a third party. If you are denied coverage you can request the insurance service providing company to rethink or reconsider their decision. In such a case insurers need to respond why they have denied the claim or coverage. But before appealing a health care decision it is pertinent to know about the insurance appeal rights as well as what decisions can be appealed and also types of appeals are available under the law. So, let us now discuss about these points in a brief.

What kind of decisions can appeal or challenged?

Based on your income, exemptions, eligibility, or other information provided by you can file an appeal against that insurance service provider. The following categories of Marketplace decisions can be appealed –

  1. i) Eligibility or qualification to buy or purchase a plan from the marketplace.
  2. ii) Eligibility for exemption from the individual responsibility requirement.

iii) Eligibility based on your income.

  1. iv) Eligibility for Medicaid Plan or Children Health Insurance Program (CHIP).
  2. v) Eligibility regarding the purchase of a health care plan from the marketplace.

Vi) Whether one can take part or register in a marketplace plan exterior of the Open Enrollment Program or OEP.

The rights of appeal under the Affordable Care law.

Before appealing for any decision it is quite prudent or apt to understand the basic rights of appeal. The rights are as follows-

  1. i) A right to appeal autonomously or independently also known as the external appeal, where a person can appeal individually with a third party or a lawyer.
  2. ii) A right to observe and acknowledge every information used in the internal appeal decision;

iii) A right to information and knowledge on why a claim or coverage has been withheld.

Important information about the appeal.

There is a certain vital aspect that one needs to know while opting for appeal.

  1. i) A person has the right to appeal a marketplace insurance plan but that should be within 90 days from the 1st month of bill issuance.
  2. ii) Time frame of appeal needs to be considered with importance.

iii) A person can opt for two types of appeal -internal & external.

The Obama care health reform law with a right to appeal service provider’s decision has made the legislation quite suitable for the citizens of the country.

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