title: External review of health plan denials of mental health services: lessons from Minnesota.
abstract: There has been concern that health plans unfairly deny claims for mental health services. This study examines a unique Minnesota program that resulted from a legal settlement. An independent panel reviews all mental health service denials in the state's three largest health plans. Our study analyzed every case file (N = 4717) the panel reviewed from January 2002 to August 2005. This unique dataset provides insight into health plan behavior. The findings show that the panel reversed only 2.9% of denied claims, suggesting inappropriate denials were rare. However, the panel decisions have made important improvements in contract language and patient communications.
authors.affiliation: Division of Health Services Research and Policy, School of Public Health, University of Minnesota, 420 Delaware Street SE, MMC 729, Minneapolis, MN 55455, USA. foote003@umn.edu
authors.forename: Susan Bartlett
authors.initials: SB
authors.lastname: Foote
authors.forename: Beth A
authors.initials: BA
authors.lastname: Virnig
authors.forename: Lindsay
authors.initials: L
authors.lastname: Bockstedt
authors.forename: Zeia
authors.initials: Z
authors.lastname: Lomax
mesh_terms: D006801:Humans; D007345:Insurance Claim Review / Q000458:organization & administration*; D007349:Insurance, Health, Reimbursement; D001523:Mental Disorders; D008605:Mental Health Services / Q000191:economics*; D008910:Minnesota