Ohio’s Patient Protection Act, which allows qualified consumers to appeal the denial, reduction or termination of health care services by their health carrier, has saved Ohioans more than $5.5 million since May 2000 – including more than $850,000 in 2004 – Insurance Director Ann Womer Benjamin announced.
The annual Patient Protection Act report was delivered this week to Ohio General Assembly leadership and Gov. Taft, who signed the Act into law on July 13, 1999 expanding protection for Ohio’s health care consumers. In the 56 months since the program began, 2,401 cases have been evaluated through external independent review organizations (IRO) and contract reviews.
“If consumers have been denied health insurance benefits and have exhausted their insurer’s internal appeal process, they can take advantage of this service at no personal cost,” Womer Benjamin said. “I encourage Ohioans to call the Department’s consumer hotline at 1-800-686-1526 or visit our Web site at www.ohioinsurance.gov for assistance.”
The Patient Protection Act provides consumers who have been previously denied coverage for a health insurance claim or have had coverage reduced or terminated the right to request an IRO to review the case.
Under the statute, the review must be completed in 30 days, and expedited reviews involving serious health issues must be completed within seven days. External reviews are assigned to one of five randomly selected organizations accredited by the Department.
In cases where the dispute involves contractual matters such as coverage limits or definitions of coverage, the Department conducts the review internally.
Decisions by the IRO in favor of the consumer are binding on the insurer, while consumers retain the right to file private lawsuits even if the IRO decision is not in their favor. Consumers do not bear the cost of an external or contractual review.
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