Do employers voluntarily include patient protections in self-insured managed care plans?
Managed care patient protection laws passed by states do not apply to health plans sponsored by self-insured employers, although 54% of workers who receive health insurance coverage through their employer are in self-insured plans. In-depth interviews conducted in five states with employers offering self-insured health benefits and with other knowledgeable market informants provide evidence that self-insured managed care plans nonetheless include important features that strengthen subscribers' access to medical providers. Less common in these plans were features providing for independent external appeal of coverage denials and for protecting network providers from undue influence by plan administrators.
Lawlor
Janice S
JS
Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1063, USA. jlawlor@wfubmc.edu
Hall
Mark A
MA
D019461:Employee Retirement Income Security Act; D006264:Health Benefit Plans, Employee / Q000145:classification / Q000458:organization & administration*; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008329:Managed Care Programs; D028701:Patient Rights; D014481:United States