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Policy holder protection

To the Editor:

Supporters of the Affordable Care Act (ACA) can point to section 11 that gives policy holders the right to appeal coverage decisions. We should all question why decision-making powers have only been in the hands of insurance companies. Policy holders should have a seat at the table of negotiating what is in their own interests.

The 2010 law states that internal appeals must be completed within 60 days if the appeal is for a service that was already received. At the end of the internal appeals process, the insurance company must provide a written decision. If the insurance company still denies the payment for a service, an external review can be allowed.

When I was laid off of my job in 2004, I paid $1,135 a month for family COBRA insurance. BlueCross BlueShield refused to make any payments for health care services for 8 months. My husband had cancer and it was vital that Mayo Clinic had their payments so that he could be treated. The new law would have made it easier for me to appeal their rejection of all claims once I was no longer an active employee. Urgent requests can now be expedited within 4 days as needed.

Julie Stewart Ziesman, Waukee

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