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Benefit Claims and Health Care Reform: Internal Claims and Appeals and External Review Procedures under PPACA


Health care reform has made important changes to how health plans and arrangements must review benefit claims.  What rights and procedures now must employers and insurers offer to participants or insured persons whose health benefit claims have been denied?  Generally, the approach has been to standardize the internal and external claim review process, applying ERISA claims procedure rules to most health plans and arrangements.  This briefing will consider the following:

Review the existing ERISA claims procedure regulation.

Summarize the new internal claims and appeals requirements under the Interim Final Rule, both for plans and individual policies.

Consider the external review process requirements, both the state process and the federal process.

Analyze the transition relief available to plan sponsors under sub-regulatory guidance.

Consider steps plan sponsors should take now to comply with the Interim Final Rule.

Presented by
Benjamin J. Evans
Carl C. Lammers

Wednesday, June 15, 2011

Registration: 7:30 - 8:00 AM
Program: 8:00 - 9:00 AM


To Register

Greenebaum Doll & McDonald PLLC
Suite 1100
300 West Vine Street
Lexington, Kentucky 40507

For additional information or questions about the program, please contact Aaron Riley, (502) 587-3771 or


Greenebaum Doll & McDonald PLLC

300 West Vine Street

Suite 1100

Lexington, Kentucky 40507


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