External Appeal of Adverse Health Plan Decisions

The Affordable Care Act (ACA) added many protections for the consumer of health care. One of them is the right to appeal decisions made by your health plan (as long as the health plan was created after March 23, 2010). Prior to the enactment of the ACA, consumers could only appeal an adverse decision through the internal process of their health plan. Oftentimes, these appeals were strenuous and unsuccessful.

Now, thanks to the ACA, the consumer can ask an independent and neutral decision maker to review the health plan’s adverse decision. In Colorado, the Division of Insurance is a great resource for consumers who have questions regarding an adverse decision they have received from their health plan. On their consumer assistance website, you can file a complaint against the health plan or request assistance with the appeals process.

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