External Review of Health Plan Decisions in the States and Medicare
An analysis of the external review process, the formal dispute resolution process established by state or federal agencies, independent of disputing parties, that has the capacity to evaluate and resolve at least those disputes involving medical issues. This paper identifies critical features of external review systems in thirteen states and in the Medicare program.
also of interest
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- Comparison of Consumer Protections in Three Health Insurance Markets: Medicare Advantage, Qualified Health Plans and Medicaid Managed Care Organizations
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