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Administration and Policy in Mental Health and Mental Health Services Research

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01-01-2007 | Original Paper

External Review of Health Plan Denials of Mental Health Services: Lessons from Minnesota

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

Published in: Administration and Policy in Mental Health and Mental Health Services Research | Issue 1/2007

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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Title: External Review of Health Plan Denials of Mental Health Services: Lessons from Minnesota
Authors: Susan Bartlett Foote
Beth A. Virnig
Lindsay Bockstedt
Zeia Lomax
Publication date: 01-01-2007
Publisher: Springer US
Published in: Administration and Policy in Mental Health and Mental Health Services Research / Issue 1/2007
Print ISSN: 0894-587X
Electronic ISSN: 1573-3289
DOI: https://doi.org/10.1007/s10488-006-0074-y

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External Review of Health Plan Denials of Mental Health Services: Lessons from Minnesota

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