Educational Resources

Healthcare Reform Government Releases

Uniform Health Carrier External Review Model Act promulgated by the National Association of Insurance Commissioners (NAIC Model Act) on July 23, 2010
http://www.naic.org/documents/committees_b_uniform_health_carrier_ext_rev_model_act.pdf

HHS will not take any enforcement action against an issuer that complies with the interim compliance method that will be detailed by HHS on the OCIIO website
http://www.hhs.gov/ociio/

Model notices that can be used to satisfy the disclosure requirements of the interim final regulations are posted on the DOL’s website. These include the following:
(1) A notice of adverse benefit determination (http://www.dol.gov/ebsa/IABDModelNotice2.doc);
(2) A notice of final internal adverse benefit determination (http://www.dol.gov/ebsa/IABDModelNotice1.doc); and
(3) A notice of final external review decision (http://www.dol.gov/ebsa/IABDModelNotice3.doc).

DOL published Technical Release 2010-01
www.dol.gov/ebsa

How to Appeal a Health Claim Denial
http://www.consumeraffairs.com/news04/2010/06/health_claim_denials.html

Fighting Denied Claims
http://www.nytimes.com/2010/02/06/health/06patient.html?pagewanted=1&ref=health

IRO and Transparency
www.psqh.com/sepoct08/peer.html

Consumer Options
http://online.wsj.com/article/SB122230334120773621.html

State External Review Programs
2008- http://www.ahipresearch.org/PDFs/StateExternalReviewReport.pdf

New Regulations to Help Consumers Appeal Decisions by Their Health Plans
http://www.healthcarereformmagazine.com/article/new-regulations-to-help-consumers-appeal-decisions-by-their-health-plans.html

Memorandum – Health Reform Implementation
http://www.admere.com/docs/health_reform_implementation.doc

The latest in a series of AHIP surveys shows that the market for individually purchased coverage is more affordable and accessible than may be widely known

http://www.ahipresearch.org/pdfs/2009IndividualMarketSurveyFinalReport.pdf

NAIRO White Paper on How to Interpret the New Internal and External Appeals Regulations

http://nairo.org/_pdf/uploads/nairo_appeals_whitepaper.pdf