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

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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.

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