As a result, they would force employers to reduce health coverage for their workers or drop it altogether. We believe that the rules under discussion today undercut that delicate balance. Here are a five of the most important examples with respect to major medical coverage. Timeframes are unreasonable The proposed regulations contain a number of extremely short timeframes that, in many cases, would be impossible to meet from a practical, real-world perspective. While larger plans may be able to meet this requirement during non-peak periods, it is not reasonable to expect all plans to adjudicate all claims within this timeframe.
Some claims are more difficult to review than others.
And sometimes it is necessary to contact providers or other third parties to appropriately review a claim. Several large HIAA members estimate that staffing costs would rise by 50 percent to 75 percent or even more if this regulation were implemented. The proposed rule would lead to increased and unnecessary litigation by allowing claimaints to bypass review and appeal processes altogether in the event of a minor procedural defect. We urge the Department to remove this pro-litigation provision. Moreover, the regulations would foreclose arbitration at the internal review stage.