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Seniors Flocking to Medicare Advantage Now Have
Guide for Handling Disputes
Aug. 4, 2005 – With the push by Medicare to expand
use of Medicare Advantage Plans (Health Maintenance Organizations and
Preferred Provider Organizations) for the healthcare of senior citizens,
increasing numbers of those on Medicare are joining these programs,
which with the governments help, often offer more-for-less than
traditional Medicare and supplemental insurance. Now there is an online
guide available to help consumers in resolving disputes with their
health plans.
The Kaiser Family Foundation and Consumers Union
today released an updated guide - A Consumer Guide to Handling Disputes
with Your Employer or Private Health Plan, 2005 Update. It includes
information about how consumers can take advantage of their health
plans' internal processes to resolve disputes, as well as external
review processes as allowed under state laws.
The vast majority of all Americans now receive
their health coverage from Preferred Provider Organizations, Health
Maintenance Organizations, or other types of managed care plans. This
guide can help consumers to understand their coverage under these plans,
their rights under the governmental rules that health plans must follow,
and the role that state external review programs play in resolving
disputes.
"Problems with health plans often arise during the
course of a health crisis, making it especially difficult for consumers
to resolve these issues successfully," Kaiser Family Foundation
president Drew E. Altman said. "This guide provides valuable information
to help people navigate what is often a confusing health insurance
system."
The guide includes state-by-state details on the
external review programs in the 43 states and the District of Columbia
that have such programs, including Arkansas and Nevada which implemented
programs after the 2003 version of this guide was issued.
The updated guide also includes a new section about
experiences with state external review programs, including data about
the outcomes of consumers' appeals to state programs. The guide also
provides tips for avoiding some common mistakes that may prevent
consumers from properly filing and successfully resolving disputes
through external appeals.
"States told us that consumers often make mistakes
in filing their appeals," said Trudy Lieberman, Director of the Center
for Consumer Health Choices at Consumers Union. "Too often they don't
follow their state's rules or they don't bring sufficient documentation
or their medical records when they begin the appeal process."
The guide was developed under a partnership between
the Kaiser Family Foundation and the Center for Consumer Health Choices
at Consumers Union. The updated version of this consumer guide is
available for free on the Kaiser Family Foundation's website at
http://www.kff.org/consumerguide, or the Consumers Union website at
www.ConsumersUnion.org/health/hmo-review. An article about health
plan choices, which highlights the guide and its information on how to
appeal health plan denials of care, is included in the September issue
of Consumer Reports magazine, which is published by Consumers Union.
The Kaiser Family Foundation is a non-profit,
private operating foundation dedicated to providing information and
analysis on health care issues to policymakers, the media, the health
care community, and the general public. The Foundation is not associated
with Kaiser Permanente or Kaiser Industries.
Consumers Union, the nonprofit publisher of
Consumer Reports, is an expert, independent nonprofit organization whose
mission is to work for a fair, just, and safe marketplace for all
consumers and to empower consumers to protect themselves. To achieve
this mission, we test, inform, and protect. To maintain our independence
and impartiality, CU accepts no outside advertising, no free test
samples, and has no agenda other than the interests of consumers. CU
supports itself through the sale of our information products and
services, individual contributions, and a few noncommercial grants.
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