External review of health plan denials of mental health services: lessons from Minnesota.
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.
Foote
Susan Bartlett
SB
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
Virnig
Beth A
BA
Bockstedt
Lindsay
L
Lomax
Zeia
Z
D006801:Humans; D007345:Insurance Claim Review / Q000458:organization & administration*; D007349:Insurance, Health, Reimbursement; D001523:Mental Disorders; D008605:Mental Health Services / Q000191:economics*; D008910:Minnesota