Obama Administration Empowers Consumers to Appeal Adverse Health Plan Decisions

Today, the U.S. Department of Health and Human Services (HHS) issued new rules enabling consumers to appeal adverse health plan decisions and offered grants to fund independent offices of consumer assistance (i.e., ombudsman) programs that can help consumers with their grievances. The following is the statement of Ron Pollack—Executive Director of the health care consumer organization, Families USA, and the sole consumer representative of the commission appointed by President Clinton to craft the initial Patients’ Bill of Rights—about this development:

“For many years, America’s consumers wanted the right to appeal adverse health plan decisions to an objective and unbiased decision-maker. Thankfully, with the new rules issued today, consumers throughout the nation, irrespective of the health plan they are in, will be empowered to contest wrongful decisions.

“This new nationwide right is essential so that consumers are not improperly denied needed care or forced to spend unaffordable amounts for such care.

“The right to appeal will be all the more meaningful because the Administration is offering grants to ombudsman programs so that they can help consumers exercise their new appeal rights. This is important because, often when consumers face an adverse health plan decision, they are frail and have difficulty pursuing their rights.  

“We applaud the Obama Administration for empowering health care consumers and creating a fair process for contesting grievances between health care consumers and insurance plan administrators.”

###

Families USA is the national organization for health care consumers. It is nonprofit and nonpartisan and advocates for high-quality, affordable health care for all Americans.

1201 New York Avenue NW, Suite 1100 · Washington, DC 20005
202-628-3030 · Email: info@familiesusa.org · www.familiesusa.org