Does Iowa's Health Care External Review Process Replace Common-Law Rights?

AuthorWade S. Hauser
PositionJ.D. Candidate, The University of Iowa College of Law
Pages1401-1429
1401
Does Iowa’s Health Care External Review
Process Replace Common-Law Rights?
Wade S. Hauser
ABSTRACT: The Patient Protection and Affordable Care Act (“ACA”)
established a federal external review process that enabled covered persons to
appeal to independent reviewers if their health insurers deny coverage for a
particular health care service. The ACA also required each state to
implement an adequate external review process. Iowa’s appellate courts have
not decided whether the external review process is “exclusive”—meaning
covered persons must use the process to challenge insurers’ adverse benefit
determinations—or “cumulative”—meaning covered persons may bypass
the process and file an action in a district court. This Note argues that
Iowa’s external review process is cumulative. The application of two rules of
statutory interpretation—the new-right test and the comprehensive-scheme
test—suggests that courts should construe Iowa’s external review statute as
a supplement to, rather than a replacement of, a covered person’s common-
law rights against an insurer. While the external review process provides a
covered person with beneficial protections and a faster, less expensive, and
often more convenient means to challenge an insurer’s denial of coverage, its
short statute of limitations, exclusion of oral testimony, and limited
jurisdiction may motivate a covered person to pursue traditional litigation
in some circumstances.
I. INTRODUCTION .................................................................................... 1403
II. BACKGROUND ...................................................................................... 1405
A. EXTERNAL REVIEW PROCESSES BEFORE THE ACA AND BARRIERS TO
EXTERNAL REVIEW ......................................................................... 1405
B. THE CURRENT EXTERNAL REVIEW PROCESS ..................................... 1408
1. The ACA’s Consumer Protection Requirements ............... 1411
2. Iowa’s Amended External Review Process ......................... 1411
J.D. Candidate, The University of Iowa College of Law, 2014; B.A., St. Olaf College,
2009. I would like to thank the writers and editors of the Iowa Law Review for their assistance
with this Note. I would also like to thank my friends and family for their continuous support.
1402 IOWA LAW REVIEW [Vol. 99:1401
III. MAY A COVERED PERSON BYPASS THE EXTERNAL REVIEW PROCESS? ... 1413
A. LEGISLATIVE INTENT AND THE TEXT OF IOWAS EXTERNAL REVIEW
STATUTE ........................................................................................ 1414
B. WHETHER IOWAS EXTERNAL REVIEW STATUTE CREATES A NEW
RIGHT ........................................................................................... 1418
1. Whether the New-Right Test Requires a Completely
New Right ............................................................................. 1419
2. Application of the New-Right Test to Iowa’s External
Review Statute ....................................................................... 1420
C. WHETHER IOWAS EXTERNAL REVIEW STATUTE CREATES A
COMPREHENSIVE SCHEME ............................................................... 1421
1. Definition of the Comprehensive-Scheme Test and
Application in Lamb ............................................................. 1421
2. Application of the Comprehensive-Scheme Test to
Iowa’s External Review Statute ............................................ 1422
D. PUBLIC POLICY GOALS INDICATE THAT THE EXTERNAL REVIEW
PROCESS SHOULD BE CUMULATIVE .................................................. 1426
IV. THE STAKES FOR COVERED PERSONS AND LITIGATION
CONSIDERATIONS ................................................................................. 1427
V. CONCLUSION ....................................................................................... 1429

To continue reading

Request your trial

VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy. ACCEPT