Jennifer Low
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Authorizing Medical Payment
Jennifer Low replied to karen1027's topic in Health Plans (Including ACA, COBRA, HIPAA)
Don't forget that the beneficiary has the right under the ACA to an External Review by independent IRO. I would suggest that the plan administrator never override the denial - allow the 1 (maybe 2) internal level appeals play out and then if beneficiary opts for it, should use External Review which is the final and binding decision.