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Full-Text Articles in Insurance Law
Increasing Consumer Power In The Grievance And Appeal Process For Medicare Hmo Enrollees, Kenneth J. Pippin
Increasing Consumer Power In The Grievance And Appeal Process For Medicare Hmo Enrollees, Kenneth J. Pippin
University of Michigan Journal of Law Reform
Federal law requires that Health Maintenance Organizations (HMOs) and Managed Care Organizations (MCOs) provide Medicare beneficiaries with specific grievance and appeal rights for challenging adverse decisions of these organizations. The Health Care Financing Administration (HCFA) is charged with enforcing these regulations. Currently, however, HCFA contracts with HMOs, allowing them to enroll Medicare beneficiaries despite the fact that many of the statutory and regulatory requirements are ignored by the Medicare HMOs. This is problematic because the elderly Medicare population may not be able to independently and adequately challenge the HMO's denial of care or reimbursement. Because HCFA has been reluctant and …
Chicago Hope Meets The Chicago School, Gail B. Agrawal
Chicago Hope Meets The Chicago School, Gail B. Agrawal
Michigan Law Review
Twenty-five years after the enactment of the Federal Health Maintenance Organization Act and nearly five years after the failure of proposed federal health care reform, managed care has come to dominate the medical marketplace. As a result, the relationships among patients, payers, and physicians have changed fundamentally and dramatically. In this market-driven environment, health care - how much it costs, who receives treatment, and who pays for it - may have surpassed the weather as a topic of everyday conversation at dinner tables and water coolers across the country. In the popular press, reports concerning managed care, usually derogatory, are …
Democratizing Hmo Regulation To Enforce The "Rule Of Rescue", Kent G. Rutter
Democratizing Hmo Regulation To Enforce The "Rule Of Rescue", Kent G. Rutter
University of Michigan Journal of Law Reform
Despite heightened public concern about HMOs, misguided regulatory measures have not guaranteed HMO patients access to the treatment options many consider vital. This Note recommends four changes to the current regulatory system that would preserve HMOs' ability to control health care costs while allowing patients and doctors, rather than lawmakers or HMO administrators, to set health care priorities.