Under the Affordable Care Act, insurer may refuse to accept an internal appeal on a denied claim if

Question

Certilyst · Accepted Answer

C Rationale: Insurers may refuse to accept an internal appeal on a denied claim if the appeal is filed more than 180 days after the claim denial. This time limit is established under the Affordable Care Act to ensure timely resolution of disputes regarding claims.

Choice A is incorrect because the Affordable Care Act does not specify a minimum claim amount for internal appeals, so the claim amount being under $500 does not disqualify an appeal.

Choice B is wrong since the ACA does not impose an appeal fee that would affect the right to appeal; thus, inability to pay an appeal fee is not grounds for refusal.

Choice D is also incorrect because the ACA does not limit the number of appeals an insured can submit within a calendar year, allowing multiple appeals regardless of frequency.

New York Life Accident and Health Insurance Practice Exam NY

Under the Affordable Care Act, insurer may refuse to accept an internal appeal on a denied claim if