Abstract
There has been concern that health plans unfairly deny claims for mental health services. This study examines a unique Minnesota program that resulted from a legal settlement. An independent panel reviews all mental health service denials in the state’s three largest health plans. Our study analyzed every case file (N = 4717) the panel reviewed from January 2002 to August 2005. This unique dataset provides insight into health plan behavior. The findings show that the panel reversed only 2.9% of denied claims, suggesting inappropriate denials were rare. However, the panel decisions have made important improvements in contract language and patient communications.
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Authors thank the University of Minnesota’s Consortium on Law and Values in Health, Environment & the Life Sciences for its support of this project.
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Foote, S.B., Virnig, B.A., Bockstedt, L. et al. External Review of Health Plan Denials of Mental Health Services: Lessons from Minnesota. Adm Policy Ment Health 34, 38–44 (2007). https://doi.org/10.1007/s10488-006-0074-y
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DOI: https://doi.org/10.1007/s10488-006-0074-y