A patient's right to appeal
When a patient's medical treatment for a serious illness fell into an unproven or experimental gray area, insurers could refuse to pay for it without having to give an explanation. Some states had consumer protections in place for these rare instances; others did not.
Under health care reform, private insurers must tell you why your claim was denied and the steps you can take to challenge their decision. If your health insurance company still denies coverage after its required internal review, you can request an external review by an independent organization with the power to overturn the decision.
"This issue dates back to what kind of health care is known to be effective," Chollet says. "Since we didn't have and still don't have any arbiter of what is considered effective health care, any innovation in health care can be deemed experimental, and coverage can be denied. One of the goals of health care reform is to establish those standards of care."
Corlette calls Obamacare's right-to-appeal provision a step in the right direction.
"This is the first time we've had a national standard for internal and external appeals," she says.