Review process seldom used. (Short Takes News at Deadline).You can give health plan members rights, but you can't make them use them. At least that seems to be the case according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. a report released by the Kaiser Family Foundation The Henry J. Kaiser Family Foundation (KFF), or just Kaiser Family Foundation, is a U.S.-based non-profit, private operating foundation headquartered in Menlo Park, California. . When researchers at Georgetown University's Institute for Health Care Research and Policy took a look at external review programs set up by states around the country they found plan members seldom use this right of appeal. That's despite the fact that almost half the time, the external reviewers sided with the patient and overturned the insurer's treatment denial. Nationwide, reviewers reversed treatment denials 45 percent of the time. The reversal rate ranged from a low of 21 percent in Arizona Arizona (âr'əzō`nə), state in the southwestern United States. It is bordered by Utah (N), New Mexico (E), Mexico (S), and, across the Colorado R., Nevada and California (W). and Minnesota to a whopping 72 percent of the time in Connecticut However; only a minuscule minuscule Lowercase letters in calligraphy, in contrast to majuscule, or uppercase letters. Unlike majuscules, minuscules are not fully contained between two real or hypothetical lines; their stems can go above or below the line. number of cases are go through the external appeals process. New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of has the highest number of appeals, but even there only 10.7 cases per 100,000 cases were externally reviewed. Elsewhere, the review rate was much lower. Researchers identified a number of factors that hold down the external appeal. A key reason is that many states require a health plan's internal review process be used before turning to an external review. The report, "Assessing State External Review Programs and the Effects of Pending Federal Patients' Rights The legal interests of persons who submit to medical treatment. For many years, common medical practice meant that physicians made decisions for their patients. This paternalistic view has gradually been supplanted by one promoting patient autonomy, whereby patients and Legislation" is available on the Internet at www.kff.org/content/2002/3221. James A. Hawkins is a health care writer based in Aiken, S.C. He can be reached by phone at 803/414-2062 or by e-mail at hirt@jx.netcom.com. |
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