How to Resolve Problems with Managed Care Plans

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How to Resolve Problems with Managed Care Plans

Postby patoco » Sun Jun 11, 2006 8:03 am

How to Resolve Problems with Managed Care Plans

Lymphedema People


How to Resolve Problems with Managed Care Plans

Updated Consumer Guide Explains How to Resolve
Problems with Managed Care Plans

Guide Includes Information about Health Plan Internal Dispute
Resolution and External Review Programs in 43 States and D.C.

Washington, D.C.

August 4, 2005, 9:00 a.m. EST

The Kaiser Family Foundation and Consumers Union
today released an updated guide to help consumers through the process of resolving disputes with their health plans. The resource, A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan, 2005 Update, includes information about how consumers can take advantage of their health plans' internal processes to resolve disputes, as well as external review processes as
allowed under state laws.

The vast majority of Americans now receive their health coverage from Preferred Provider Organizations, Health Maintenance Organizations, or other types of managed care plans. This guide can help consumers to understand their coverage under these plans, their rights under the governmental rules that health plans must follow, and the role that state external review programs play in resolving

Problems with health plans often arise during the course of a health
crisis, making it especially difficult for consumers to resolve these issues successfully, Kaiser Family Foundation president Drew E. Altman said. This guide provides valuable information to help people navigate what is often a confusing health insurance system.?

The guide includes state-by-state details on the external review
programs in the 43 states and the District of Columbia that have such programs, including Arkansas and Nevada which implemented programs after the 2003 version of this guide was issued.

The updated guide also includes a new section about experiences with
state external review programs, including data about the outcomes of
consumers appeals to state programs. The guide also provides tips for avoiding some common mistakes that may prevent consumers from properly filing and successfully resolving disputes through external appeals.

"States told us that consumers often make mistakes in filing their
appeals," said Trudy Lieberman, Director of the Center for Consumer Health Choices at consumers Union. "Too often they don't follow their state's rules or they don't bring sufficient documentation or their medical records when they begin the appeal process."

The guide was developed under a partnership between the Kaiser Family Foundation and the Center for Consumer Health Choices at Consumers Union. The updated version of this consumer guide is available for free on the Kaiser Family Foundation's website at:

or the Consumers Union website at:

An article about health plan choices, which highlights the guide and its information on how to appeal health plan denials of care, is included in the September issue of Consumer Reports magazine, which is published by Consumers Union.


The Kaiser Family Foundation is a non-profit, private operating
foundation dedicated to providing information and analysis on health care issues to policymakers, the media, the health care community, and the general public. The Foundation is not associated with Kaiser Permanente or Kaiser Industries.

Consumers Union, the nonprofit publisher of Consumer Reports, is an expert, independent nonprofit organization whose mission is to work for a fair, just, and safe marketplace for all consumers and to empower consumers to protect themselves. To achieve this mission, we test, inform, and protect. To maintain our independence and impartiality, CU accepts no outside advertising, no free.

test samples, and has no agenda other than the interests of consumers. CU supports itself through the sale of our information products and services, individual contributions, and a few noncommercial grants.
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