Pennsylvania Program to Review Health Insurance Denials 

By Consumers for Quality Care, on February 14, 2024

The Pennsylvania Insurance Department recently launched its Independent Review Program, which aims to offer consumers another chance to have their medical appeal reviewed when their insurer has already denied an initial appeal for a medical procedure or medication, according to WHYY News.  

The Independent Review Program will involve a team of doctors, specialists, and other experts who together will be charged with reviewing denials by insurance companies. If the review determines that coverage was wrongly denied, the health insurer will be required to overturn the denial and to cover the service in question. Most cases are expected to be resolved within 60 days.  

According to Shannen Logue, Deputy Commissioner of the Insurance Department, consumers should know that they have options and recourse should their insurer deny coverage. “It’s a really important thing that people are doing and using those rights that they have to challenge those denials,” said Logue, noting that the program will “really serve as a notice to health insurers to do a better job reviewing the claim the first time.” 

CQC applauds programs that give health care consumers more protections, especially against insurance company denials. Consumers should know that they have options and rights if their insurer denies coverage.