Categorized | Colorado News, National News, News

“Appeal Rights” on Colorado DOI Radar

The Colorado Division of Insurance has issued a statement regarding a California lawsuit in which an Aetna insured was denied coverage for a medical procedure.  In the deposition phase, a former medical director stated that he did not actually review patients’ records when deciding on authorization.  He relied on the opinions of Aetna nurses who had reviewed the files.

Given Aetna’s national presence, Colorado’s Interim Insurance Commissioner has reiterated that “Colorado consumers’ appeal rights are offered in compliance with Colorado law.  Colorado law states that in an appeal to the insurance company, the reviewing physician must be familiar with Colorado standards of care, and must evaluate the appeal to include reviewing it with other specialists if in an area outside the physician’s expertise and must sign a written determination of the case.

Read about your rights from this Division of Insurance directive.

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