Part of an excellent Professional Interview Series directed towards health professionals. A short list of compelling arguments when seeking redress from MCO's. The Corporate Perspective Large corporations are beginning to review the evidence of how managed care typically benefits the insurers more than either the companies or the employees. There is a panel of providers, but an employee can recommend a non-panel provider of their choice, who, if meeting the necessary professional credentials and submitting two sample treatment cases, will usually be accepted as a provider. There is no pre-certification.
Fees vary depending on location.
There is a quality check case review after 20 sessions, with no impact on the continuation of treatment. The American Psychiatric Association is going to court to protect the right of patients to receive optimal care for their mental illnesses, APA President Harold I. Eist, M.D., announced today. Opposing arbitrary and capricious denials of medically necessary care through financial support of class action lawsuits against Blue Cross Companies which use Green Spring Health Services to review the medical necessity of psychiatric and substance abuse treatment decisions. The actions were approved by the APA Trustees Friday March 14, 1997. They are part of the Association's proactive litigation strategy and are supported through a special fund created in 1995.