Kaiser Publishes Guide to Handling Health Plan Disputes

January 24, 2003
A new online resource developed by Consumers Union and the Kaiser Family Foundation provides state-specific guidelines and practical information on how to resolve health plan disputes.

Anyone enrolled in a health plan should be familiar with their plan's internal review process and any external review program in their state in case problems later arise.

Forty one states plus the District of Columbia have legislated procedures for resolving disputes outside the health plan through “external review” systems, yet studies show these systems are not well utilized, a Kaiser press release said. Also, new federal requirements for the processing of employer health plan claims and appeals of denied claims are effective January 1, 2003.

A separate 2001 survey by the Kaiser Family Foundation and Harvard University School of Public Health found that almost half (48%) of privately insured adults under age 65 had a problem with their health plan in the last year with a range of consequences from minor hassles to adverse effects on their health. This guide will help consumers navigate their plan’s internal claims review procedure, as well as their state’s external review process.

The guide is available on Kaiser's Web site at http://www.kff.org/content/2003/20030123a/