Resolving Disputes Guide

The Kaiser Family Foundation and Consumers Union today released an updated guide to help consumers through the process of resolving disputes with their health plans. The resource, A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan, 2005 Update , 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 vast majority of Americans now receive their health coverage from Preferred Provider Organizations, Health Maintenance Organizations, or other types of managed care plans. This guide can help consumers to understand their coverage under these plans, their rights under the governmental rules that health plans must follow, and the role that state external review programs play in resolving disputes. 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 E. Altman said.

This guide provides valuable information to help people navigate what is often a confusing health insurance system. The guide includes state-by-state details on the external review programs in the 43 states and the District 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. The guide also provides tips for avoiding some common mistakes that may prevent consumers from properly filing and successfully resolving disputes through external appeals. "States told us that consumers often make mistakes in filing their appeals," said Trudy Lieberman, Director of the Center for Consumer Health Choices at Consumers Union. "Too often they don't follow their state's rules or they don't bring sufficient documentation or their medical records when they begin the appeal process."

The guide was developed under a partnership between the Kaiser Family Foundation and the Center for Consumer Health Choices at Consumers Union. The updated version of this consumer guide is available for free on the Kaiser Family Foundations website or the Consumers Union website. In addition, an article about health plan choices, which highlights the guide and its information on how to appeal health plan denials of care, is included in the September issue of Consumer Reports magazine, which is published by Consumers Union.

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The guide can be found at, http://www.kff.org/consumerguide/7350.cfm


For more information on this and other important updates, please see:
www.RSDHope.org
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