Harrisburg, Pa. — The Pennsylvania Insurance Department (PID) announced that 259 Pennsylvanians successfully appealed denied health service claims through PID’s new Independent External Review process.
In total, the external review process overturned 50% of appealed denials, helping to ensure more Pennsylvanians receive the health services they deserve and marking a strong start for the process’s first year.
The independent external review provides Pennsylvanians an additional opportunity to appeal a denial after their health insurance company completes an internal review process. Prior to the bipartisan enactment of Act 146 of 2022 , Pennsylvanians could only request an external review through a federal government process. This act brought the external review to the state level, providing a faster outlet for Pennsylvanians to request a review. PID now oversees this process and is in charge of determining whether or not a claim is eligible for review, any related communications with consumers, and the assignment of the reviews to a certified independent review organization…