Coverage Decisions Versus the Quality of Care: An Analysis of Recent ERISA Judicial Decisions and Their Implications for Employer-Insured Individuals

Authors

Sara J. Rosenbaum, George Washington UniversityFollow
Joel B. Teitelbaum, George Washington UniversityFollow

Document Type

Report

Publication Date

4-2000

Series

Behavioral Health Issue Brief Series No. 8

Keywords

ERISA; Managed Care; Managed Care Contracting

Abstract

This Issue Brief, prepared for the Substance Abuse and Mental Health Services Administration, examines the evolution of this framework for analyzing health claims emanating from the conduct of ERISA-covered managed care arrangements and considers its implications for the provision of treatment for mental illness and addiction disorders. Both studies and anecdotal evidence suggest that managed care companies impose particularly rigorous controls over treatment for mental illness and addiction disorders. It is therefore perhaps not surprising that legal challenges to treatment decisions frequently involve individuals with these conditions. Consequently, to the extent that courts are in fact on the verge of re-conceptualizing their approach to analyzing managed care cases under ERISA, the implications for treatment of mental illness and addiction disorders may be especially significant.

Comments

Funder: SAMHSA.

Recommended Citation

Rosenbaum, Sara J. and Teitelbaum, Joel B., "Coverage Decisions Versus the Quality of Care: An Analysis of Recent ERISA Judicial Decisions and Their Implications for Employer-Insured Individuals" (2000). Health Policy and Management Issue Briefs. Paper 16.
https://hsrc.himmelfarb.gwu.edu/sphhs_policy_briefs/16

Open Access

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