External review of health plan denials of mental health services: lessons from Minnesota
| Autor: | Lindsay A. Bockstedt, Susan Bartlett Foote, Zeia Lomax, Beth A Virnig |
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| Rok vydání: | 2006 |
| Předmět: |
Mental Health Services
medicine.medical_specialty HRHIS Mental health law business.industry Health Policy Public health Mental Disorders Minnesota Public Health Environmental and Occupational Health International health Mental health humanities Psychiatry and Mental health Insurance Claim Review Health promotion Family medicine Health care Insurance Health Reimbursement medicine Humans Pshychiatric Mental Health business health care economics and organizations Health policy |
| Zdroj: | Administration and policy in mental health. 34(1) |
| ISSN: | 0894-587X |
| Popis: | There has been concern that health plans unfairly deny claims for mental health services. This study examines a unique Minnesota program that resulted from a legal settlement. An independent panel reviews all mental health service denials in the state’s three largest health plans. Our study analyzed every case file (N = 4717) the panel reviewed from January 2002 to August 2005. This unique dataset provides insight into health plan behavior. The findings show that the panel reversed only 2.9% of denied claims, suggesting inappropriate denials were rare. However, the panel decisions have made important improvements in contract language and patient communications. |
| Databáze: | OpenAIRE |
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