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in Rationing by Inconvenience: How Insurance Denials Induce Administrative Burdens
> Journal of Health Politics, Policy and Law
Published: 01 August 2024
Journal Article
J Health Polit Policy Law (2024) 49 (4): 539–565.
Published: 01 August 2024
...Figure 4 Methods of appealing coverage denials. ...
FIGURES
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Journal Article
J Health Polit Policy Law (1999) 24 (5): 1099–1106.
Published: 01 October 1999
.... How-
ever, outright denials of coverage for services are relatively rare. When
health plans have set up independent review processes for patient appeals,
they are infrequently used. While this may be partially due to people not
knowing about the appeals processes or how to use them, it is much...
Journal Article
J Health Polit Policy Law (2005) 30 (3): 427–452.
Published: 01 June 2005
... on Physician Satisfaction . Unpublished manuscript. Studdert, D. M., and C. R. Gresenz. 2003 . Enrollee Appeals of Preservice Coverage Denials at Two Health Maintenance Organizations. Journal of the American Medical Association 289 : 867 -870. Swartz, Katherine. 1999 . The Death of Managed Care...
Journal Article
J Health Polit Policy Law (1994) 19 (3): 633–642.
Published: 01 June 1994
... it. It wasn’t the
first time they’ve lost our stuff.
Interestingly, Medicare was among the worst offenders with respect to
these tactics. Respondents also reported coverage denials from Medicare
because a service was experimental or not precertified before rendered.
As one respondent lamented...
Journal Article
J Health Polit Policy Law (2017) 42 (5): 995–1002.
Published: 01 October 2017
... under Trump, a few asked me if I could give them a ray of hope. Well, here's a small one. But it's only small, and it's very fragile. Even if a federal legislative brake on outright coverage denials remains in place, we should scrutinize how insurers continue to squeeze out sick people by manipulating...
Journal Article
J Health Polit Policy Law (2007) 32 (5): 785–818.
Published: 01 October 2007
...’ best hope for recovery.
Litigation often follows the denial of coverage, inserting the courts into
difficult and contentious scientific disputes. The litigants, especially the
individuals whose lives may depend on receiving the recommended treat-
ment, have a direct stake in how the case...
Journal Article
J Health Polit Policy Law (2014) 39 (2): 417–440.
Published: 01 April 2014
... Studdert David M. “External Review of Coverage Denials by Managed Care Organizations in California.” Journal of Empirical Legal Studies 2005 2 no. 3 449 68 Griffin Robert B. Woodcock Janet “Comparative Effectiveness Research: Who Will Do the Studies?” Health Affairs 2010 29...
Journal Article
J Health Polit Policy Law (2001) 26 (2): 409–428.
Published: 01 April 2001
... to a leaner norm: “Don’t do it, unless you can demon-
strate its value.” Under this new rule even common, widely accepted clin-
ical routines have met coverage denials, and irate providers are scram-
bling to gather the kind of data necessary to document the value...
Journal Article
J Health Polit Policy Law (1999) 24 (5): 941–947.
Published: 01 October 1999
... are often the underlying cause of denials
of service to policy holders.
Second, the employer’s influence on managed care organizations
occasionally even extends to coverage decisions about specific medical
services. Employers are increasingly using their new role as insurer to
customize the coverage...
Journal Article
J Health Polit Policy Law (1997) 22 (6): 1385–1411.
Published: 01 December 1997
... areas of antidiscrimination law to examine these developments and to provide a framework for making health care decisions that are consistent with these new legal interpretations. This article addresses decisions in individual cases, treatment policies adopted by health care providers, and coverage...
Journal Article
J Health Polit Policy Law (2023) 48 (3): 405–434.
Published: 01 June 2023
...-of-network providers and facilities. This result speaks to the limitations of government interventions, such as the No Surprises Act, that only address specific situations in which patients receive unexpected medical costs. While respondents deem insurance coverage denials to be just as unfair as “surprise...
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Journal Article
J Health Polit Policy Law (1999) 24 (5): 1137–1144.
Published: 01 October 1999
... another four hundred managed care laws, including twenty-eight
comprehensive packages. Two states—Texas and Missouri—took the
debate further by voting to allow consumers to sue their health plans
in state courts for damages caused by a denial or delay in coverage of
needed care.
While final figures...
Journal Article
J Health Polit Policy Law (2003) 28 (5): 859–882.
Published: 01 October 2003
... and increase beneficiary access to Medicare coverage. This article reports the findings of the first national study of these Medicare maximization billing practices for home care services. Primary data were collected to determine which states conduct retrospective Medicare billing practices and the amounts...
Journal Article
J Health Polit Policy Law 11825370.
Published: 28 February 2025
... to use Medicare s coverage rules when determining what counts as medically necessary care (Hellmann 2023) while a 2024 rule seeks to streamline prior authorization processes. Providers also have expressed frustration with low payments, prior authorization requirements, and frequent claims denials...
Journal Article
J Health Polit Policy Law (1999) 24 (6): 1275–1304.
Published: 01 December 1999
... that coverage
denials are often arbitrary and unfair (Butler 1997).
Although medical malpractice, in general, is not regarded as a signifi-
cant factor in deterring substandard medical care by individual physi-
cians, empirical research has demonstrated that its deterrence signal is felt...
Journal Article
J Health Polit Policy Law (1999) 24 (5): 1115–1126.
Published: 01 October 1999
... Image Campaigns to Combat Hostile Environment. Wall Street Journal, 21 September, B8. Kaiser Family Foundation. 1998 . Media Coverage of Managed Care. Menlo Park, CA: Princeton Survey Research Associates/Kaiser Family Foundation. Kassirer , Jerome . 1997a . Practicing Medicine without...
Journal Article
J Health Polit Policy Law (2017) 42 (6): 1065–1098.
Published: 01 December 2017
... therapies and educational and developmental services Micheletti v. State Health Benefits Com'n , 913 A.2d 842, 850 (N.J. Super. Ct. App. Div. 2007) “Denial of coverage for Jake's prescribed treatment is couched in terms of the contractual exclusion of benefits for non-restorative speech, physical...
Journal Article
J Health Polit Policy Law (2013) 38 (2): 373–391.
Published: 01 April 2013
... affordability and use of needed
care. The law curbs or eliminates many practices that have been common
in the private insurance market, including annual and lifetime limits on
coverage, retroactive policy cancellation, coverage denial or limitation
because of preexisting medical conditions, and gender...
Journal Article
J Health Polit Policy Law (2014) 39 (6): 1173–1183.
Published: 01 December 2014
... accepting private insurance. Data on discriminatory denials of care to children with public insurance came from an audit study involving 273 practices across seven medical specialties serving children in Cook County, Illinois. These data were linked to physician workforce data and neighborhood poverty data...
View articletitled, Factors Associated with Increased Specialty Care Access in an Urban Area: The Roles of Local Workforce Capacity and Practice Location
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