ODI Offers Information on the Patient Protection Act

The Department of Insurance (ODI) has begun a patient awareness program - through a statewide radio campaign - to inform patients of their rights under the Patient Protection Act, an act that allows patients to appeal health insurance coverage denials. The Patient Protection Act provides consumers who have been previously denied coverage for a health insurance claim the right to request an external independent review organization (IRO) to review the case. Under the statute, the review must be completed in 30 days, and expedited reviews involving serious health issues must be completed within seven days. External reviews are assigned to one of five randomly selected organizations accredited by the department. Patients are not responsible for the cost of the external review -- the health insurer must cover the cost for the review. Decisions by the IRO in favor of the patient are binding for the insurer, while patients still retain their right to file private lawsuits even if the IRO decision is not in their favor. In cases where the dispute involves contractual matters such as coverage limits or definitions of coverage, the ODI conducts the review internally. Since the start up of this program over 1,200 reviews have been conducted, resulting in the recovery of $3,505,689 in previously denied insurance benefits for patients. The ODI noted that last year they resolved 10,300 consumer complaints. Health insurance claim denials and health insurance claim delays were the top complaints from consumers to the ODI. Patients that want more information about the Act may call a hotline number toll-free (800) 686-1526 or go to the department's web site at www.ohioinsurance.gov.