Idaho Department of Insurance to review denied health insurance claims

Idaho consumers whose health insurance companies refuse to pay the bill for necessary health and medical services will have a new tool on their side in their coming year. Under the Health Carrier External Review Act, starting January 1, the Idaho Department of Insurance will review denied health insurance claims to help ensure consumers aren't wrongfully denied coverage. The act was signed into law by Governor 'Butch' Otter in April and sponsored by Senator Dean Cameron and Representative Russ Mathews.

"Too often consumers have to battle with their insurance companies to get the care and the coverage they need," said Jim Wordelman, State Director for AARP in Idaho. "AARP commends Governor Otter for his leadership on this issue and Senator Cameron and Representative Mathews for providing Idaho consumers with a new resource to make sure their health care claims are not wrongfully denied."

Under the act, consumers who've been denied a claim by their health insurance carrier will be able to appeal to the Department of Insurance for an external review. Claims denied for either "medical necessity" or "investigational service or supply" may then be reviewed after the consumer has exhausted the insurance carrier's review process. The findings from the review will be binding, meaning if the claim was wrongfully denied, the insurance carrier will have to pay.

"This move helps put the interests of Idaho consumers before those of insurance company profits," added Wordelman. "As Congress moves closer to crucial health care reforms at the national level, Idaho's state leaders are stepping up to the plate to ensure consumers aren't unfairly treated by their health insurance carrier."