Health Plan Internal Consumer Dispute Resolution Practices: Highlights from a National Study
Year: 2002
Type: article
Abstract: disputes in the private commercial arena, as well as in Medicare and Medicaid, and to identify workable options for improving the process. A. Overview and Study RationaleHealth maintenance organizations (HMOs)' and other managed health care plans continue to capture a growing share of the health care delivery market.Between 1994 and 1998, the number of HMO plans climbed 62.2%, from 556 to 902; and between 1994 and 1999 HMO market penetration increased nearly 17% to reach 37.9%.4At the same time, the number of government beneficiaries enrolling in managed care continues to grow. 5 The growth of managed care has brought advantages in cost control, preventive care and the potential of coordinating treatmenta feature especially critical for members who are elderly, chronically ill or who have disabilities.6 However, the rise of managed care also raises compelling questions concerning the scope of coverage, authorization for services and the "gatekeeper" concept, physician/patient/ plan communications, physician payment rates, quality of careand how best to resolve plan-enrollee differences about care and payment.3. A "health maintenance organization" (HMO) is "a type of managed-care plan that acts as both insurer and provider of a comprehensive set of health care services to an enrolled population.Benefits are typically financed through capitation with limited copayments, and services are furnished through a system of affiliated providers."PHYSICIAN PAY-
Authors: Naomi Karp, Erica Wood
Language: English
Subfield: Law
Field: Social Sciences
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W202128403