The Law and Your Health

Basics of Managed Care

How does this affect me?

The insurance company influences the decision of your doctor by limiting the care for which the company will pay. What used to be a decision between you and your doctor is now a decision between you, your doctor and your health plan. You either must abide by your managed care policy or pay for the treatment out of your own pocket. Let’s assume, for example, that your health plan allows you to stay in the hospital for 48 hours after giving birth, unless there is a medical necessity for a longer stay. Not every woman is physically ready to be on her own within 48 hours after childbirth. Yet you may either have to leave the hospital or pay for any further treatment yourself.

>>How is managed care defined?
>>What are some of the concerns with managed care?
>>How does this affect me?
>>What are the states doing to ensure that patients get the care they need within the managed care system?
>>What are some specific legal protections for consumers?

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