ERISA Health Plan Denials: Exploring Models for External Review

Authors

Karl Polzer, George Washington University

Document Type

Issue Brief

Publication Date

6-19-1998

Abstract

This paper outlines the current process under the Employee Retirement Income and Security Act (ERISA) by which plan participants can appeal a claim denial as well as changes to the claims procedure requirements being considered by the Department of Labor. It describes state legislative activity in this area and summarizes research describing practices currently in place among managed health care organization. The paper also describes two existing models for external review of managed care plan decisions, one used by the Medicare program and another by the state of Florida.

Comments

Issue brief no. 720

Recommended Citation

Polzer, Karl, "ERISA Health Plan Denials: Exploring Models for External Review" (1998). National Health Policy Forum. Paper 2.
https://hsrc.himmelfarb.gwu.edu/sphhs_centers_nhpf/2

Open Access

yes