Second opinions on coverage.
It's the main complaint about managed care: Doctor and patient agree on a specific treatment, but the HMO refuses to pay for it. Until recently, the only remedy available to patients was long and costly lawsuits. Now, patients and health plans are finding that external review boards--panels of independent experts--offer an inexpensive and fair alternative for resolving such disputes.
Benko
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D016265:Conflict of Interest; D003657:Decision Making; D006801:Humans; D007343:Insurance Carriers; D007345:Insurance Claim Review / Q000331:legislation & jurisprudence; D019458:Insurance Coverage / Q000331:legislation & jurisprudence; D020380:Needs Assessment; D012017:Referral and Consultation / Q000331:legislation & jurisprudence; D013219:State Government; D014481:United States; D014600:Utilization Review / Q000458:organization & administration*