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| ARBITRATION Your health plan may offer or in some cases may require that you resolve your dispute through a process called arbitration. Arbitration is a process in which two parties present their views of a dispute to a neutral third party -- an arbitrator -- who will then decide how to resolve the dispute. Arbitration may be binding, in which case the parties agree ahead of time to abide by the arbitrator’s decision, or it may be non-binding, in which case the arbitrator’s decision is simply advisory. Federal ERISA regulations provide that if an employer-sponsored health plan uses arbitration as part of its internal review, the arbitration must follow the same federal rules that apply to any internal appeal, including one that says you cannot be charged a fee for the arbitration. If your employer-sponsored health plan requires that you enter into mandatory arbitration, it must be one of the two allowed levels of internal appeal, and you may challenge the arbitrator’s decision in court (in other words, the arbitrator’s decision can’t be binding). Your employer-sponsored plan may offer you voluntary arbitration (including binding arbitration), but only if you have completed the plan’s internal review and the plan has provided you with sufficient information to enable you to make an informed judgment about whether or not to use voluntary arbitration. If your health plan has voluntary arbitration, your decision to use or not use this alternative does not affect your rights to any other plan benefits such as payment for other covered treatments. If you decide not to use voluntary arbitration, your health plan cannot use this against you in subsequent appeals. Also, your state may have rules that regulate how your plan can use arbitration. If your plan requires that you agree to arbitration to settle disputes over claims for benefits, you may want to contact your state insurance commissioner to determine what your rights might be. |
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