Improving health is our policy
Added by section 10107 of the Manager’s Amendment. Requires a GAO study on the incidence of denials of coverage for medical services – including the types of services and reasons for denial – as well as denials of applications to enroll in health insurance plans by group health plans and health insurance issuers. Report is due by March 23, 2011.
GAO issued the report, “Private Health Insurance: Data on Application and Coverage Denials,” on March 16, 2011.
SEC. 1562. GAO STUDY REGARDING THE RATE OF DENIAL OF COVERAGE
AND ENROLLMENT BY HEALTH INSURANCE
ISSUERS AND GROUP HEALTH PLANS.
[Section inserted by section 10107(b)(2)]
(a) IN GENERAL.—The Comptroller General of the United
States (referred to in this section as the ‘‘Comptroller General’’)
shall conduct a study of the incidence of denials of coverage for
medical services and denials of applications to enroll in health insurance
plans, as described in subsection (b), by group health plans
and health insurance issuers.
(b) DATA.—
(1) IN GENERAL.—In conducting the study described in subsection
(a), the Comptroller General shall consider samples of
data concerning the following:
(A)(i) denials of coverage for medical services to a plan
enrollees, by the types of services for which such coverage
was denied; and
(ii) the reasons such coverage was denied; and
(B)(i) incidents in which group health plans and
health insurance issuers deny the application of an individual
to enroll in a health insurance plan offered by such
group health plan or issuer; and
(ii) the reasons such applications are denied.
(2) SCOPE OF DATA.—
(A) FAVORABLY RESOLVED DISPUTES.—The data that
the Comptroller General considers under paragraph (1)
shall include data concerning denials of coverage for medical
services and denials of applications for enrollment in
a plan by a group health plan or health insurance issuer,
where such group health plan or health insurance issuer
later approves such coverage or application.
(B) ALL HEALTH PLANS.—The study under this section
shall consider data from varied group health plans and
health insurance plans offered by health insurance issuers,
including qualified health plans and health plans that are
not qualified health plans.
(c) REPORT.—Not later than one year after the date of enactment
of this Act, the Comptroller General shall submit to the Secretaries
of Health and Human Services and Labor a report describing
the results of the study conducted under this section.
(d) PUBLICATION OF REPORT.—The Secretaries of Health and
Human Services and Labor shall make the report described in subsection
(c) available to the public on an Internet website.
[The following section 1563 (relating to small business procurement)
inserted by section 10107(b)(2)]
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