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Full-Text Articles in Law
Managed Care, Utilization Review, And Financial Risk Shifting: Compensating Patients For Health Care Cost Containment Injuries, Vernellia R. Randall
Managed Care, Utilization Review, And Financial Risk Shifting: Compensating Patients For Health Care Cost Containment Injuries, Vernellia R. Randall
Vernellia R. Randall
This Article examines current tort remedies for personal injury claims and explores the problems that arise when these remedies are applied to physicians' actions that are directed by third-party payers. Part II of this Article explores the organization and historical development of managed health care products. Part III considers the past and present uses of the utilization review process and financial risk shifting. Part IV explores the applicability of traditional theories of tort liability to third-party payers, including direct liability of third-party payers who market managed care products. Part V considers the barriers that ERISA presents to compensating patients for …
Protective Plan Provisions For Employer-Sponsored Employee Benefit Plans, Kathryn J. Kennedy
Protective Plan Provisions For Employer-Sponsored Employee Benefit Plans, Kathryn J. Kennedy
Kathryn J. Kennedy
Federal case law has provided plan sponsors of the Employee Retirement Income Security Act of 1974 (ERISA) covered plans with the ability to insert plan provisions that are more favorable to the plan sponsor rather than the plan participant or beneficiary (so-called “protective plan provisions”). This Article first examines what is the “plan document” for purposes of ERISA and what protective plan provisions should be considered for insertion into the plan document and its related “instruments.”