Appeals Process

Plans that renew on or after 09/23/10 must comply with the new appeals process which gives the consumer more options to appeal a denied claim.  New internal and external appeals processes must follow HHS guidelines, and new state law protocol.

The appeals process mirrors that for Medicare beneficiaries who are covered under a Medicare Advantage Plan.  The new appeals process does not apply to grandfathered plans.

Burman S. Clark

Burman S. Clark, RHU, CSA is the President of Muneris Benefits and a licensed insurance broker and consultant. His independent practice and focuses on employee benefits, individual life, disability, medical, and senior products. Burman has traveled extensively and provided guidance to large employer associations with regards to the Affordable Care Act.