As part of the Patient Protection and Affordable Care Act (PPACA) of 2010, expanded appeal rights for patients have been granted in all states. These regulations grant the right to both an internal appeal through the insurance plan, as well as an independent external appeal.
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Some states already have some consumer protection laws; however, the PPACA sets the minimum standard. Other provisions of this law also further extend patient protection in the following ways:
- Requiring insurance plans to give consumers detailed information about the denial along with information on how to appeal.
- Expedited appeals for urgent cases such as emergency room visits.
- Restricted appeal costs for the consumer. The health plan is responsible for the remainder of the appeal costs.
Plans that were in existence before implementation of this PPACA policy that have not undergone substantial changes are "grandfathered in" and will not be