Such an appeal system must be expedient, particularly in situations that threaten the life or health of the patient, and conducted by appropriately credentialed individuals. External Appeals . Individuals must have access to an external, independent body with the capability and authority to resolve disputes for cases involving medical judgment. The plan must pay the costs of the process, and any decision is binding on the plan. If a plan refuses to comply with the external reviewer s determination, the patient may go to federal court to enforce the decision.
Consumers have the right to know all of their treatment options.
The Bipartisan Consensus Bill prohibits plans from gagging doctors and from retaliating against providers who advocate on behalf of their patients. It protects providers in these situations from retribution. It also prevents plans from providing inappropriate incentives to providers to limit medically necessary services. Provider Selection . Providers should not be discriminated against based on the basis of license in selection for plan participation.