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https://www.healthaffairs.org/doi/full/10.1377/hlthaff.16.1.158
Consumer Protection In Managed Care: Finding The Balance ... on the other hand, the need to allow managed care organizations to evolve and experiment, to generate ongoing savings, and, it is hoped ...Cited by: 6
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.15.3.110
Consumer Protection And Managed Care: The Need For Organized Consumers. ... powerful consumer organizations and alliances do not exist yet because formidable obstacles make it difficult to ...Cited by: 64
https://www.dmhc.ca.gov/FileaComplaint.aspx
Contact information for health care-related organizations, useful terms and fact sheets. ... Home > File a Complaint. File a Complaint. Independent Medical Review & Complaint Process. ... For more information about IMR and Consumer Complaints, please visit our Frequently Asked Questions.
https://www.ncbi.nlm.nih.gov/books/NBK233033/
J Medicare Managed Care: Protecting Consumers and Enhancing Satisfaction. ... paper is to examine sources of Medicare health plan enrollee satisfaction and dissatisfaction and mechanisms to address consumer complaints through appeals processes and government oversight. The paper is …Author: Stanley B. Jones, Marion Ein Lewin
https://aspe.hhs.gov/report/consumer-protection-private-health-insurance-role-consumer-complaints/4-grievances-internal-complaints-received-health-insurance-plans-are-potentially-rich-data-source-examining-implementation
Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. 4. Grievances (internal complaints received by health insurance plans) are a potentially rich data source in examining the implementation of patient protections. ... Complaints About Managed Care and Indemnity Insurance.
https://www.health.pa.gov/topics/facilities/managed%20care/Pages/Managed%20Care.aspx
Managed Care. The Department of Health reviews, approves, licenses and monitors the quality of care provided to consumers by health maintenance organizations (HMOs) and other managed care systems. The department promotes innovation in the health care marketplace by encouraging the development of alternative health delivery systems.
https://www.state.nj.us/dobi/division_insurance/managedcare/mcfaqs.htm
The Department has an office within Consumer Protection Services that handles complaints from consumers and health care providers regarding coverage and/or payment under a managed care plan, including: complaints primarily concerning quality of care, choice and accessibility of health care providers, issues relating to the adequacy of the ...
https://www.illinois.gov/hfs/MedicalProviders/cc/Pages/ManagedCareComplaints.aspx
The provider portal was created for providers to submit complaints to HFS about issues you are experiencing with Illinois Medicaid Managed Care Organizations (MCOs) in an electronic and secure format. Our goal is to answer MCO-related questions promptly and ensure fair resolution of disputes involving MCOs and providers.
https://aspe.hhs.gov/report/consumer-protection-private-health-insurance-role-consumer-complaints/jurisdiction-and-responsibility-consumer-complaints-systems-5
Jurisdiction and Responsibility for Consumer Complaints Systems ... creating BISHCA also strengthened regulatory responsibility and changed the focus from solely HMOs to managed care organizations more broadly. ... Both offices are cognizant of maintaining consumer confidentiality and will not discuss individual consumer complaints across the ...
https://www.health.ny.gov/health_care/managed_care/billofrights/bill.htm
Managed Care Bill of Rights. Article 44 of the New York State Public Health Law gives these rights to enrollees of managed care organizations. You may also …
https://www.dmhc.ca.gov/HealthCareinCalifornia/ResourceList.aspx
Health Care Consumer Assistance. Department of Managed Health Care (DMHC) Help Center Assistance with problems with health coverage and with health plan grievances and appeals 1-888-466-2219 (many languages) 1-877-688-9891 (TDD) www.Healthhelp.ca.gov (many languages) California Department of Insurance
https://www.health.ny.gov/health_care/managed_care/mcplans.htm
The Managed Care Organization Directory includes all Health Maintenance Organizations, Prepaid Health Services Plans, Special Needs Plans, and Primary Care Partial Capitation Providers certified by the NYS Department of Health. Included are plan contact information and payment programs the plan ...
https://www.state.nj.us/dobi/division_insurance/managedcare/index.htm
Managed Care Entities: Health Maintenance Organizations (HMOs) Selective Contracting Arrangements (SCAs) Organized Delivery Systems (ODS) Workers' Compensation Managed Care Organizations (WCMCOs) Dental Plan Organizations (DPOs) Dental Service Corporations (DSCs) Other Entities: Third Party Administrators (TPAs) Third Party Billing Services (TPBs)
https://www.hca.wa.gov/billers-providers-partners/programs-and-services/managed-care
Deliver health care organized around managed care techniques and concepts. Changes to managed care. The Health Care Authority (HCA) implemented changes to the Apple Health managed care program. Learn more about these changes. How can I become a managed care provider? To provide care for a client enrolled in managed care, providers are required ...
https://dfr.vermont.gov/reg-bul-ord/consumer-protection-and-quality-requirements-managed-care-organizations
PART 1 GENERAL PROVISIONS Section 1.1 Purpose. The purpose of this rule is to set forth the consumer protection and quality requirements that managed care organizations shall meet in order to further the purposes of its enabling statutes.
http://www.hmohelp.ca.gov/
Today, the California Department of Managed Health Care (DMHC) announced enforcement action against a dozen health plans, including fines totaling $1.9 million, for lack of oversight of a contracted medical group which led to improper denials and delays of enrollees’ care.
https://ahca.myflorida.com/Inside_AHCA/docs/REV_07_29_2019Organization%20and%20Operation%20Statement.pdf
The Agency for Health Care Administration is authorized in Section 20.42, Florida Statutes. It is the chief health policy and planning entity for the state. The Agency is responsible for health facilities licensure, inspection, and regulatory enforcement; investigation of consumer complaints related to health care facilities and managed care
http://www.consumers.org/q&anet.htm
The potential for managed care plans to impede access to needed services and providers is the leading consumer concern under managed care and is why the independent monitoring of the quality of care is imperative. 4. Can Consumer Access to Needed Care be Assured and Monitored Under Managed Care?
https://www.disabilityrightsca.org/publications/consumer-information-for-complaints-about-health-care-professionals-facilities-and
Jun 01, 2018 · Consumer Information for Complaints about Health Care Professionals, Facilities, and Programs. ... Many Medi-Cal managed care plans are licensed by DMHC and therefore the consumer protections available in private or commercial plans are also available to Medi-Cal beneficiaries. ... Consumer complaints: The Dental Board of CA's 'Consumer ...
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