Millions of Americans receive their employer-based health care benefits through self-insured employer plans. These plans are now subject to new rules under PPACA, one of the most troubling is the requirement to have an external claims appeal procedure using designated independent review organizations. The American Benefits Council represents many of these companies and has written to the Department of Labor expressing the employer concerns about this aspect of PPACA. The concern employers have are related to the administrative complexity, new administrative expenses and the short time frames involved in this process. The broad brush used by PPACA (typical of federal legislation) imposes burdensome requirements where they are least needed. No group is more diligent in assuring the fair payment of health care claims than large employers who are self-funding their employee’s benefits.
New external claim review procedures
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