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.
|Original language||English (US)|
|Number of pages||7|
|Journal||Administration and Policy in Mental Health and Mental Health Services Research|
|State||Published - Jan 2007|
- External review
- Mental health claims
- Public policy