NU Online News Service, Sept. 23, 3:00 p.m.EDT

NEW YORK–Get ready for the Patient Protection andAffordable Care Act (PPACA) and all the uncertainties that go withit, including major Constitutional issues regarding the claimsappeals process, according to a panel of legal experts here.

Rhonda D. Orin, managing partner of Anderson Kill & Olick(AKO) Washington D.C. office and a member of the firm's InsuranceRecovery Group, was a speaker at the Anderson Kill & OlickAnnual Policyholder Conference today. She noted that the new healthreform law raises many Constitutional issues.

"It is impossible to imagine this won't be challenged straightto the Supreme Court," she said "That is the only place because itis a Constitutional issue."

The "holes" created by heath reform surface within the new rulesregarding the internal and external claims and appeals process.

Whether an employee is the chief executive officer or the mailroom clerk, appeals of claims will be handled by acontractually-paid, independent reviewer. Ms. Orin predicted thereform would spawn a "cottage industry of claims-decidingcompanies." This reviewer, paid for by the health plans, willgather evidence similar to a court of law and its decision is saidto be binding.

Problems are expected to occur if a claimant chooses to go on tothe federal external review process – which has yet to bedeveloped, said Terry Connerton, Counsel to the law firm of BakerHostetler, who was also on the panel.

"No one knows how the courts will give deference tocontractually-paid deciders," Ms. Orin said. "This is a really bigthing. What is the standard of review? What does binding mean?"

Certain mandates of the PPACA start Sept. 23, including theinternal and external claims appeal procedures, with many more tocome over the next several years on this date, said Ms. Orin.

Litigation also is likely to be generated by questionssurrounding preemption, said Tess J. Ferrera, partner at Miller& Chevalier.

Sprinkled within the provisions, said Ms. Ferrera, is thedeclaration "that this is a floor" – that "if state law is moreprotective it is not preempted" and there is no distinction betweenself-funded and fully insured plans.

Certain group health plans are not subject to health care reformprovisions and are considered grandfathered, Ms. Ferrera explained.However there are many ways to lose grandfather status, shenoted.

"Many clients have given up trying to maintain grandfatherstatus," she said. The status is applied to each benefit packageand any change in the policy will end grandfather status, Ms.Ferrera continued.