FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W239602366> ?p ?o ?g. }

• W239602366 startingPage "79" @default.
• W239602366 abstract "Managed care disputes can have an urgency often lacking in the fee-forservice system. Conflicts frequently occur before treatment rather than after. Enrollee health and wellbeing may be at stake-and justice delayed truly may be justice denied. Moreover, conflicts may arise out of intemal HMO decisions riddled by tension between the health needs of and the cost constraints of the plan. And consumers-often traumatized by health concernsmay sometimes be in the dark about who made the decision, on what grounds and with what evidence, and where to turn next. Finally, processes for resolving disputes in managed care vary depending on the payer-with Medicare, Medicaid, state laws, and Employee Retirement Income Security Act procedures differing dramatically. To make matters more difficult, there is not even a common language on managed care dispute resolution. Words like complaint, grievance, and appeal often are used interchangeably with little agreed-upon definition. We know that are experiencing a variety of difficulties in obtaining care from managed care organizations. A survey of consumer experiences in managed care conducted by the Lewin Group last summer revealed that 27 percent of managed care households surveyed had experienced a difficulty with their health plan in the previous twelve months. A fair number of those with problems (29 percent) had taken no action to resolve them; among those who sought resolution of their difficulties, 54 percent were dissatisfied with the resolution or had not yet resolved the problem. Clearly, if managed care is going to work, procedures for addressing consumer conflicts must be timely, fair, consistent, accessible-and readily understood by enrollees. What should such procedures look like? The question is a compelling one that raises a host of knotty issues: How can the enrollee really have an opportunity to be heard? What kinds of processes would engender careful and fair review of enrollee healthcare needs? What are reasonable time frames for the resolution of consumer disputes? Of urgent care disputes? What kinds of help should have in navigating managed care problems and cutting through bureaucratic delays and impediments? Should plan decisions be reviewable by external independent entities, as now occurs in Medicare? Should services slated to be reduced or terminated be continued pending appeal? How can dispute resolution processes be most accessible to older people and people with disabilities? How much do dispute resolution processes cost? These issues have been in the forefront recently in several arenas. One is Medicare. The Balanced Budget Act of I997 (BBA) creates a new program, Medicare + Choice (Medicare Part C), of which HMOs and other managed care plans for Medicare beneficiaries will be a part. The new statute contains language on appeals and grievance procedures that is similar to existing law and regulations. The BBA required the Health Care Financing Administration to publish regulations establishing standards for the Medicare+Choice program by June 1, 1998. As of this writing, HCFA plans to include regulations on grievance and appeal procedures in its June 1 mega-regulation and has solicited comments on beneficiary protections. HCFA is likely to stick with its current regulation on expedited appeal procedures for certain urgent cases, but it may change time frames for other appeals and may create other new policies affecting resolution of disputes. Meanwhile, a key presidential commission also has been debating dispute resolution concerns. In March 1997, President Clinton appointed the Advisory Commission on Consumer Protection and Quality in the Health Care Industry, composed of representatives of all major stakeholders in today's healthcare arena. The president recognized the importance of dispute resolution by mandating that the commission develop a consumer bill of rights ensuring that consumers have access to simple and fair procedures for resolving health care coverage disputes with plans. …" @default.
• W239602366 created "2016-06-24" @default.
• W239602366 creator A5035251165 @default.
• W239602366 creator A5084694121 @default.
• W239602366 date "1998-07-01" @default.
• W239602366 modified "2023-09-24" @default.
• W239602366 title "Resolving Managed Care Consumer Disputes: Where Do We Stand?" @default.
• W239602366 hasPublicationYear "1998" @default.
• W239602366 type Work @default.
• W239602366 sameAs 239602366 @default.
• W239602366 citedByCount "0" @default.
• W239602366 crossrefType "journal-article" @default.
• W239602366 hasAuthorship W239602366A5035251165 @default.
• W239602366 hasAuthorship W239602366A5084694121 @default.
• W239602366 hasConcept C131676636 @default.
• W239602366 hasConcept C139621336 @default.
• W239602366 hasConcept C144133560 @default.
• W239602366 hasConcept C160735492 @default.
• W239602366 hasConcept C17744445 @default.
• W239602366 hasConcept C199539241 @default.
• W239602366 hasConcept C2777369334 @default.
• W239602366 hasConcept C2777483011 @default.
• W239602366 hasConcept C2778449503 @default.
• W239602366 hasConcept C2780265253 @default.
• W239602366 hasConcept C2780838233 @default.
• W239602366 hasConcept C39549134 @default.
• W239602366 hasConceptScore W239602366C131676636 @default.
• W239602366 hasConceptScore W239602366C139621336 @default.
• W239602366 hasConceptScore W239602366C144133560 @default.
• W239602366 hasConceptScore W239602366C160735492 @default.
• W239602366 hasConceptScore W239602366C17744445 @default.
• W239602366 hasConceptScore W239602366C199539241 @default.
• W239602366 hasConceptScore W239602366C2777369334 @default.
• W239602366 hasConceptScore W239602366C2777483011 @default.
• W239602366 hasConceptScore W239602366C2778449503 @default.
• W239602366 hasConceptScore W239602366C2780265253 @default.
• W239602366 hasConceptScore W239602366C2780838233 @default.
• W239602366 hasConceptScore W239602366C39549134 @default.
• W239602366 hasIssue "2" @default.
• W239602366 hasLocation W2396023661 @default.
• W239602366 hasOpenAccess W239602366 @default.
• W239602366 hasPrimaryLocation W2396023661 @default.
• W239602366 hasRelatedWork W151408443 @default.
• W239602366 hasRelatedWork W1607698822 @default.
• W239602366 hasRelatedWork W2016218323 @default.
• W239602366 hasRelatedWork W2018372671 @default.
• W239602366 hasRelatedWork W2199838379 @default.
• W239602366 hasRelatedWork W236562232 @default.
• W239602366 hasRelatedWork W2409416109 @default.
• W239602366 hasRelatedWork W2415025203 @default.
• W239602366 hasRelatedWork W2417167541 @default.
• W239602366 hasRelatedWork W271111159 @default.
• W239602366 hasRelatedWork W3121232935 @default.
• W239602366 hasRelatedWork W3123485884 @default.
• W239602366 hasRelatedWork W3123608141 @default.
• W239602366 hasRelatedWork W3123782612 @default.
• W239602366 hasRelatedWork W3124438226 @default.
• W239602366 hasRelatedWork W53686675 @default.
• W239602366 hasRelatedWork W643084591 @default.
• W239602366 hasRelatedWork W91097679 @default.
• W239602366 hasRelatedWork W97355602 @default.
• W239602366 hasRelatedWork W3124328124 @default.
• W239602366 hasVolume "22" @default.
• W239602366 isParatext "false" @default.
• W239602366 isRetracted "false" @default.
• W239602366 magId "239602366" @default.
• W239602366 workType "article" @default.