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What appeal rights do consumers have?

Consumers have a right to appeal an unfavorable coverage decision by their health insurance company. Insurance companies must give consumers owning an individual policy a first-level internal appeal, administered by the company, and then a second-level external review administered by an independent third party. For group policies, the insurance company may require two levels of internal appeals before the external review.

Consumers can also file complaints when claims are denied, or when they believe that their health insurance company isn't properly following the legal appeals process.

Also, if a consumer is dissatisfied with an eligibility decision made by the Health Insurance Marketplace there will be an appeals process. The consumer can contact the Marketplace for more information.

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