| |
TRENDS
Independent Medical Review Of Health Plan Coverage Denials: Early Trends
Kenneth H. Chuang,
Wade M. Aubry and
R. Adams Dudley
Concerns among patients and physicians that health plans would deny coverage for medically necessary services has brought about legislation mandating independent medical review (IMR) of denied services. Among 1,400 cases submitted in California, the most common areas for dispute were cancer care, endocrine/metabolic care (especially for obesity), orthopedic care, and neurological disorders. Surgery and pharmacy services constituted 52 percent of cases. In 58 percent of cases, IMR upheld the health plans decision, while in 33 percent of cases the health plans decision was overturned, which suggests that external IMR provides additional patient protection in Californias health care system.

What's this?
|