Lawlor Janice S, Hall Mark A
Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1063, USA.
Manag Care Interface. 2005 Jan;18(1):76-80.
Managed care patient protection laws passed by states do not apply to health plans sponsored by self-insured employers, although 54% of workers who receive health insurance coverage through their employer are in self-insured plans. In-depth interviews conducted in five states with employers offering self-insured health benefits and with other knowledgeable market informants provide evidence that self-insured managed care plans nonetheless include important features that strengthen subscribers' access to medical providers. Less common in these plans were features providing for independent external appeal of coverage denials and for protecting network providers from undue influence by plan administrators.
各州通过的管理式医疗患者保护法不适用于由自保雇主赞助的健康计划,尽管54% 通过雇主获得医疗保险的工人参加的是自保计划。在五个州对提供自保健康福利的雇主以及其他了解市场情况的人士进行的深入访谈表明,自保管理式医疗计划仍然包含一些重要特征,这些特征增强了参保人获得医疗服务提供者的机会。在这些计划中,不太常见的特征是提供对保险拒绝的独立外部申诉以及保护网络提供者免受计划管理者的不当影响。