title: Utilization review and managed health care liability.
abstract: This article explores the development of jurisprudence interpreting application of the Employee Retirement Income Security Act of 1974 to patient care denials by managed care. It identifies quality-of-care protections for patient care under present federal law. If an insurance company utilization review denies care based on patient-specific reasoning, then the patient may have recourse against the utilization review on the basis of a state law claim of malpractice grounded in medical decision-making by the insurance company.
authors.affiliation: Middleberg, Riddle & Gianna, New Orleans, LA 70170, USA. rspector@midrid.com
authors.forename: Richard A
authors.initials: RA
authors.lastname: Spector
mesh_terms: D003657:Decision Making; D019461:Employee Retirement Income Security Act; D006279:Health Maintenance Organizations / Q000331:legislation & jurisprudence; D006801:Humans; D008318:Malpractice / Q000331:legislation & jurisprudence*; D008329:Managed Care Programs / Q000331:legislation & jurisprudence*; D016079:Refusal to Treat / Q000331:legislation & jurisprudence; D013781:Texas; D014481:United States; D014600:Utilization Review / Q000331:legislation & jurisprudence*