New Health Plan Dispute Resolution Guide Unveiled

A Kaiser news release said the guide includes information about how consumers can take advantage of their health plans’ internal processes to resolve disputes as well as external review processes as allowed under state laws.

The guide includes state-by-state details on the external review programs in the 43 states and theDistrict of Columbia that have such programs, including Arkansas and Nevada which implemented programs after the 2003 version of this guide was issued.

The updated guide also includes a new section about experiences with state external review programs, including data about the outcomes of consumers’ appeals to state programs, Kaiser said. The guide also provides tips for avoiding some common mistakes that may prevent consumers from properly filing and successfully resolving disputes through external appeals

The guide can help consumers understand their coverage under their health plans, their rights under the governmental rules that health plans must follow, and the role that state external review programs play in resolving disputes, according to the announcement.

“Problems with health plans often arise during the course of a health crisis, making it especially difficult for consumers to resolve these issues successfully,” Kaiser Family Foundation president Drew Altman said, in the news release. “This guide provides valuable information to help people navigate what is often a confusing health insurance system.”

The guide is here .