Question

Explain the timeline of the ACA and the influence that it has on the quality of care that is delivered to the beneficiary, as well as the process for filing an appeal for healthcare-related services that are delayed and/or denied by the insurance company.

Answer 1

ACA- Affordable care Act, it is patient protection and ACA also called Obama Care. It provides health insurance for many americans as per health care reform law. federal regulations make health plans under the provison of ACA. It expnads medicaid program with coverage of preventive care.
In 2010 impemented children health insurance laong with parents until 26years. In 2012 Medicaid program for low-income adults. In 2013 it launched new online market place for consumers. ACA has many goals that increase the health insurance quality of care and reduces the cost of health care. it increases based Medicaid health insurance for many Americans including pre-existing conditions. medicare advantages from private plans to the traditional fee for service model provide medicare beneficiaries part A and Part B benefits. it improves patient safety, promotes high-value effective care by reducing health care costs. It includes young adult coverage, women, and older age pre-existing conditions, pregnancy care, etc. It includes 4 tier coverage like bronze, silver, gold, platinum paid by the plan. it includes emergency care.
  when health care service delayed or denied by the insurance company, review the reason for denying that insurance plans letter or summary, call the insurance company if you have a query, if you want to appeal the decision, request representative to make the process of the reason for appeal. file your complaint and call the doctor's office, when an appeal for claim insurance company look for the claim within 72 hours. the insurance company sends a letter to about its decision. If it is internal appeal when your claim is denied you have the right to an internal appeal. you can ask the insurance company to have full review of its decision. If it is urgent insurance company speed up the process. if it is the external review you have right to take an appeal to an independent third party for review. external review that the insurance company will not say anything about claim payment.