to include administrative costs.
Do you have any links for your concerns about denying legitimate claims under the ACA? Are you aware that there is an appeal process, including an outside review?
http://www.healthcare.gov/law/features/rights/appealing-decisions/index.html
What This Means for You
When an insurance plan denies payment for a treatment or service, you can request an appeal. When your plan receives your request it is required to review its own decision. For plan years or policy years beginning on or after July 1, 2011, when your plan denies a claim, it is required to notify you of:
The reason your claim was denied.
Your right to file an internal appeal.
Your right to request an external review if your internal appeal was unsuccessful.
The availability of a Consumer Assistance Program (when your state has one).
If you don’t speak English, you may be entitled to receive appeals information in your native language upon request. This right applies to plan years or policy years beginning on or after January 1, 2012.
When you request an internal appeal, your plan must give you its decision within:
72 hours after receiving your request when you’re appealing the denial of a claim for urgent care. (If your appeal concerns urgent care, you may be able to have the internal appeal and external review take place at the same time.)
30 days for denials of non-urgent care you have not yet received.
60 days for denials of services you have already received.
If after internal appeal the plan still denies your request for payment or services, you can ask for an independent external review. For plan years or policy years that begin on or after July 1, 2011, your plan must include information on your denial notice about how to request this review. If your state has a Consumer Assistance Program, that program can help you with this request.
If the external reviewer overturns your insurer’s denial, your insurer must give you the payments or services you requested in your claim.
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