Claims Appeals

[Guest deacon]

Seeking opinions on advantages of one appeal with voluntary arbitration versus two appeal procedure. What are most group health plans implementing with the new regulations?

[mal]

My understanding of the regulations with respect to voluntary arbitration is that the process is binding (if voluntary), but that all costs associated with the process must be paid by the plan. Since even a simple arbitration costs $3,000-$5,000 (exclusive of attorney fees), our plans have stayed away from arbitration. We do not want to incur the unnecessary costs associated with frivilous appeals. In the long run I personally believe that very few participants will bring a 502 action, and even if they do, the costs of defense will be much less than several arbitrations.

[Guest budman]

Any opinions or advice on the assumption that two appeals and no voluntary arbitration is the best procedure to use for claims appeals?