External review of health plan denials of mental health services: Lessons from Minnesota

Susan Bartlett Foote, Beth A. Virnig, Lindsay Bockstedt, Zeia Lomax

Research output: Contribution to journalArticle

1 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)38-44
Number of pages7
JournalAdministration and Policy in Mental Health and Mental Health Services Research
Volume34
Issue number1
DOIs
StatePublished - Jan 1 2007

Keywords

  • External review
  • Mental health claims
  • Public policy

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