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March 18, 2013

The Law and Your Health

Basics of Managed Care

What are some specific legal protections for consumers?

  • In most states there are laws that limit the pre-existing conditions that health care plans may put into their policies.
  • Usually a health care plan is required to renew health coverage for all members who pay their premiums, even if the member has become ill and requires expensive treatment.
  • Almost every state now requires that new mothers be allowed to stay in the hospital for at least 48 hours after giving birth.
  • More than half the states require health plans to pay for visits to the emergency room.
  • Some states have expanded their laws to include minimum hospital stays for mastectomy patients and to give women the right to see an obstetrician-gynecologist without going through a primary care doctor first.
  • Some states require health care plans to cover treatment for mental illness and substance abuse, as well as prenatal care and minor surgery.
  • A few states require health plans to cover chiropractic and hospice care.
  • Other states require that if a health plan covers prescription drugs then it must also cover contraceptives that are prescribed by a doctor. Less than a dozen states require that health plans offer in-vitro fertilization as part of their health plans.

>>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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