Health reform includes changes to denied claims, health savings accounts

News outlets examine some changes to the health care system that health reform will bring, including help for those with denied insurance claims and health savings account modifications.

The New York Times: "The new health law makes the system somewhat more consumer-friendly. Starting this fall, patients in all health plans can contest claim denials in an independent state-level review procedure — a recourse that has not generally been available to employees of companies that pay their employees' health claims directly." The change is significant in that more than half of all covered workers are in "self-funded" plans, but the provision won't apply to "grandfathered" plans — "those in existence on March 23. … Nor does the new law make it any easier for consumers to sue for punitive damages or for pain and suffering. Under Erisa, the Employee Retirement Income Security Act of 1974, people covered by employer health plans can sue in federal court only for the cost of the benefit that was denied them." States have independent review of denials but some require consumers to pay up to half the cost of such a review (Andrews, 6/21).

Kaiser Health News' Insuring Your Health column, on the changes to health savings accounts: "The health-care overhaul law makes two specific changes involving HSAs: Starting in January, you can no longer use those funds tax-free for over-the-counter medications unless they're prescribed by a doctor. In addition, if you use your HSA for nonmedical expenses, you'll be hit with a 20 percent penalty instead of the current 10 percent." Health policy experts argue on the accounts' usefulness and if they act as a tax-shelter for the healthy and wealthy. HSAs are available mostly to people with insurance plans with high deductibles. "Some insurers who offer high-deductible plans say the health-care overhaul is imposing new regulations that will make it harder for them to operate. Earlier this month, nHealth of Richmond announced that it was shutting its doors, saying its business model couldn't be sustained under rules that will require insurers to spend 80 to 85 percent of the amount they collect in premiums on clinical services and quality measures, or give customers a rebate" (Andrews, 6/22).

The Hill, in the meantime, reports that AARP has released its latest policy briefs to help its millions of members understand the health reform law and the changes it will bring to the system better. "The latest briefs address provisions of the reform law that expand Medicaid, help seniors receive care at home, expand the healthcare workforce and eliminate preventable hospital readmissions" (Lillis, 6/21).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.