title: Patients' satisfaction when denied authorization for emergency department care by their managed care plan.
abstract: We conducted a survey of managed care plan (MCP) patients who presented to the emergency department (ED) but were denied insurance authorization during a 3-month period. Patients were identified by triage or registration records, contacted by telephone after their visit, and surveyed regarding their satisfaction with the ED and MCP, follow-up care, and future behavior. We surveyed 72 (73.4%) of 98 subjects who were denied authorization. Forty-nine (68.1%) were redirected to a clinic or primary physician, 14 (19.4%) to an urgent care or other ED, and 9 (12.5%) were given no follow-up. Fifty-five respondents (76.4%) stated they had followed-up as directed, but 34 (47.2%) felt the delay had a negative impact. Thirty-nine (54.2%) were dissatisfied with their MCP. If their problems were to recur, 27 (37.5%) stated they would go to a clinic or call their MCP, but 34 (47.2%) would return to the ED. Many patients who are denied authorization are dissatisfied with their MCP and will return to the ED in the future, despite previous denials.
authors.affiliation: Department of Emergency Medicine, University of California San Diego Medical Center 92103, USA.
authors.forename: T C
authors.initials: TC
authors.lastname: Chan
authors.forename: S R
authors.initials: SR
authors.lastname: Hayden
authors.forename: B
authors.initials: B
authors.lastname: Schwartz
authors.forename: T
authors.initials: T
authors.lastname: Fletcher
authors.forename: R F
authors.initials: RF
authors.lastname: Clark
mesh_terms: D002140:California; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D015438:Health Behavior; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics*; D006764:Hospitals, Community; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007349:Insurance, Health, Reimbursement; D008329:Managed Care Programs / Q000191:economics* / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D012424:Rural Population; D013383:Suburban Population; D014218:Triage