Using an appeals panel to mediate mental health care UR disputes.
The certification of admission and lengthy psychiatric hospitalizations raises fundamental issues related to the appropriateness of treatment. The author presents several case examples to illustrate how an appeals panel resolves disputed utilization review decisions regarding inpatient psychiatric treatment.
Lazarus
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A
TAO, Inc., Philadelphia, PA 19103.
D003659:Decision Making, Organizational; D007345:Insurance Claim Review / Q000458:organization & administration*; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D017008:Negotiating; D011367:Professional Staff Committees; D014481:United States; D014600:Utilization Review / Q000458:organization & administration*