title: Consumer managed care appeals: are the available procedural protections fundamentally fair?
abstract: Managed care incentives to reduce costs have also resulted in incentives to deny care. Anecdotes concerning managed care denials of care have led to a consumer outcry for protection either through the use of procedural due process or by the establishment of patient rights that would include appeal and grievance protections. This Article reviews the procedural protections of constitutional due process, the Consumer Due Process Protocol, and the Patient Bill of Rights. The Article then extensively discusses the availability of these procedural protections in various public and private forums. The discussion of public forums includes proposals contained in recent national legislative initiatives. The author then reviews relevant federal and state law, as well as Uniform Law proposals. Next, the Article analyzes the protections provided by accreditation agencies, dispute resolution organizations, professional organizations, and health insurers. Finally, the author recommends criteria to be used to determine whether a procedure is fundamentally fair.
authors.affiliation: Saint Louis University School of Law, USA.
authors.forename: A H
authors.initials: AH
authors.lastname: Nevers
mesh_terms: D000368:Aged; D003657:Decision Making; D006801:Humans; D007345:Insurance Claim Review / Q000331:legislation & jurisprudence; D019458:Insurance Coverage / Q000331:legislation & jurisprudence*; D008329:Managed Care Programs / Q000331:legislation & jurisprudence*; D020398:Medicare Part C / Q000331:legislation & jurisprudence; D017008:Negotiating; D010344:Patient Advocacy / Q000331:legislation & jurisprudence*; D017149:Private Sector; D017150:Public Sector; D016079:Refusal to Treat / Q000331:legislation & jurisprudence*; D014481:United States