Health Benefit Ruling Raises Reviewer Neutrality Questions

Law360 (August 14, 2020, 3:43 PM EDT) -- The Patient Protection and Affordable Care Act[1] made a number of significant changes to health insurance coverage in the U.S. One of the most important provisions of the law, which is also known as Obamacare, was a requirement that patients whose benefits are denied are entitled to independent external review.

The implementing regulation[2] requires that such reviews be granted on request for health insurance denials involving medical judgment, determinations that the requested service is experimental or investigational, or involving cancellation of coverage based on allegations that the insured gave false information in the application for benefits.[3] The outcome of the review...

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