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Volumn 43, Issue 2, 2004, Pages 155-162

Disputes over Coverage of Emergency Department Services: A Study of Two Health Maintenance Organizations

Author keywords

[No Author keywords available]

Indexed keywords

ABDOMINAL CRAMP; ABDOMINAL MUSCLE SPASM; ABDOMINAL PAIN; AGE; ARTICLE; EAR INFECTION; EMERGENCY TREATMENT; EMERGENCY WARD; HEALTH CARE COST; HEALTH CARE FINANCING; HEALTH CARE PLANNING; HEALTH CARE POLICY; HEALTH CARE QUALITY; HEALTH INSURANCE; HEALTH MAINTENANCE ORGANIZATION; HEALTH SERVICE; HUMAN; INJURY; LACERATION; LEISURE; MAJOR CLINICAL STUDY; MANAGED CARE ORGANIZATION; OTALGIA; OUTCOMES RESEARCH; PREVALENCE; PRIORITY JOURNAL; PRIVATE HEALTH INSURANCE; STANDARD;

EID: 0942301391     PISSN: 01960644     EISSN: None     Source Type: Journal    
DOI: 10.1016/S0196-0644(03)00637-1     Document Type: Article
Times cited : (10)

References (39)
  • 2
    • 0342409390 scopus 로고    scopus 로고
    • The managed care backlash and the task force in California
    • Enthoven AC, Singer SJ. The managed care backlash and the task force in California. Health Aff (Millwood). 1998;17:95-110.
    • (1998) Health Aff (Millwood) , vol.17 , pp. 95-110
    • Enthoven, A.C.1    Singer, S.J.2
  • 4
    • 0033812396 scopus 로고    scopus 로고
    • The prudent layperson definition: Will it work for emergency medicine?
    • Williams RM. The prudent layperson definition: will it work for emergency medicine? Ann Emerg Med. 2000;36:238-240.
    • (2000) Ann Emerg Med , vol.36 , pp. 238-240
    • Williams, R.M.1
  • 5
    • 85030902780 scopus 로고    scopus 로고
    • HR2015 Balanced Budget Act of 1997. US House of Representatives; 1997
    • HR2015 Balanced Budget Act of 1997. US House of Representatives; 1997.
  • 6
    • 85030892686 scopus 로고    scopus 로고
    • Balanced Budget Act of 1997. Pub L No. 105-33 §4704
    • Balanced Budget Act of 1997. Pub L No. 105-33 §4704.
  • 7
    • 0942298490 scopus 로고    scopus 로고
    • Market failures and the evolution of state regulation of managed care
    • Sloan FA, Hall MA. Market failures and the evolution of state regulation of managed care. Law Contemp Probl. 2002;65:169-206.
    • (2002) Law Contemp Probl , vol.65 , pp. 169-206
    • Sloan, F.A.1    Hall, M.A.2
  • 8
    • 85030897568 scopus 로고    scopus 로고
    • California Health & Safety Code §1317.1(b) and §1371.4
    • California Health & Safety Code §1317.1(b) and §1371.4.
  • 9
    • 0034710633 scopus 로고    scopus 로고
    • What recourse? Liability for managed-care decisions and the Employee Retirement Income Security Act
    • Mariner WK. What recourse? Liability for managed-care decisions and the Employee Retirement Income Security Act. N Engl J Med. 2000;343:592-596.
    • (2000) N Engl J Med , vol.343 , pp. 592-596
    • Mariner, W.K.1
  • 10
    • 0033887222 scopus 로고    scopus 로고
    • Controversial company: The prudent layperson standard and the patients' bill of rights
    • Asplin BR. Controversial company: the prudent layperson standard and the patients' bill of rights. Ann Emerg Med. 2000;35:304-307.
    • (2000) Ann Emerg Med , vol.35 , pp. 304-307
    • Asplin, B.R.1
  • 11
    • 85030893279 scopus 로고    scopus 로고
    • S1052, Bipartisan Patient Protection Act, 2001
    • S1052, Bipartisan Patient Protection Act, 2001.
  • 12
    • 85030902744 scopus 로고    scopus 로고
    • HR2563, Bipartisan Patient Protection Act, 2001
    • HR2563, Bipartisan Patient Protection Act, 2001.
  • 13
    • 0029970790 scopus 로고    scopus 로고
    • Disagreement among health care professionals about the urgent care needs of emergency department patients
    • Gill JM, Reese CL, Diamond JJ. Disagreement among health care professionals about the urgent care needs of emergency department patients. Ann Emerg Med. 1996;28:474-479.
    • (1996) Ann Emerg Med , vol.28 , pp. 474-479
    • Gill, J.M.1    Reese, C.L.2    Diamond, J.J.3
  • 14
    • 0030960848 scopus 로고    scopus 로고
    • Judging who needs emergency department care: A prerequisite for policy-making
    • Lowe RA, Bindman AB. Judging who needs emergency department care: a prerequisite for policy-making. Am J Emerg Med. 1997;15:133-136.
    • (1997) Am J Emerg Med , vol.15 , pp. 133-136
    • Lowe, R.A.1    Bindman, A.B.2
  • 15
    • 0028262333 scopus 로고
    • What is an emergency? The judgment of two physicians
    • Foldes SS, Fischer LR, Kaminsky K. What is an emergency? The judgment of two physicians. Ann Emerg Med. 1994;23:833-840.
    • (1994) Ann Emerg Med , vol.23 , pp. 833-840
    • Foldes, S.S.1    Fischer, L.R.2    Kaminsky, K.3
  • 16
    • 0029961614 scopus 로고    scopus 로고
    • Triage: Limitations in predicting need for emergency care
    • Brillman JC, Doezema D, Tandberg D, et al. Triage: limitations in predicting need for emergency care. Ann Emerg Med. 1996;27:493-500.
    • (1996) Ann Emerg Med , vol.27 , pp. 493-500
    • Brillman, J.C.1    Doezema, D.2    Tandberg, D.3
  • 17
    • 0029930930 scopus 로고    scopus 로고
    • Inappropriate emergency department use: A comparison of three methodologies for identification
    • O'Brien GM, Shapiro MJ, Woolard RW, et al. Inappropriate emergency department use: a comparison of three methodologies for identification. Acad Emerg Med. 1996;3:252-257.
    • (1996) Acad Emerg Med , vol.3 , pp. 252-257
    • O'Brien, G.M.1    Shapiro, M.J.2    Woolard, R.W.3
  • 18
    • 0035016933 scopus 로고    scopus 로고
    • Appropriate standards for appropriateness
    • Lowe RA, Abbuhl SB. Appropriate standards for appropriateness. Ann Emerg Med. 2001;37:629-632.
    • (2001) Ann Emerg Med , vol.37 , pp. 629-632
    • Lowe, R.A.1    Abbuhl, S.B.2
  • 19
    • 0034124304 scopus 로고    scopus 로고
    • Underestimation of case severity by emergency department patients: Implications for managed care
    • Caterino JM, Holliman CJ, Kunsleman AR. Underestimation of case severity by emergency department patients: implications for managed care. Am J Emerg Med. 2000;18:254-256.
    • (2000) Am J Emerg Med , vol.18 , pp. 254-256
    • Caterino, J.M.1    Holliman, C.J.2    Kunsleman, A.R.3
  • 20
    • 0033822174 scopus 로고    scopus 로고
    • Results of provider self-adjudication using the prudent layperson standard compared with the managed care organization's emergency department claim review process
    • Shesser R, Holtermann K, Smith J, et al. Results of provider self-adjudication using the prudent layperson standard compared with the managed care organization's emergency department claim review process. Ann Emerg Med. 2000;36:212-218.
    • (2000) Ann Emerg Med , vol.36 , pp. 212-218
    • Shesser, R.1    Holtermann, K.2    Smith, J.3
  • 21
    • 0036142872 scopus 로고    scopus 로고
    • The prudent layperson: Definition of an emergency medical condition
    • Li J, Galvin HK, Johnson SC. The prudent layperson: definition of an emergency medical condition. Am J Emerg Med. 2002;20:10-13.
    • (2002) Am J Emerg Med , vol.20 , pp. 10-13
    • Li, J.1    Galvin, H.K.2    Johnson, S.C.3
  • 22
    • 0036147167 scopus 로고    scopus 로고
    • Managed care gatekeeping, emergency medicine coding, and insurance reimbursement outcomes for 980 emergency department visits from four states
    • Young GP, Ellis J, Becher J, et al. Managed care gatekeeping, emergency medicine coding, and insurance reimbursement outcomes for 980 emergency department visits from four states. Ann Emerg Med. 2002;39:24-30.
    • (2002) Ann Emerg Med , vol.39 , pp. 24-30
    • Young, G.P.1    Ellis, J.2    Becher, J.3
  • 23
    • 0030881384 scopus 로고    scopus 로고
    • Denial of emergency department authorization of potentially high-risk patients by managed care
    • Zautcke JL, Fraker LD, Hart RG, et al. Denial of emergency department authorization of potentially high-risk patients by managed care. J Emerg Med. 1997;15:605-609.
    • (1997) J Emerg Med , vol.15 , pp. 605-609
    • Zautcke, J.L.1    Fraker, L.D.2    Hart, R.G.3
  • 24
    • 0033882974 scopus 로고    scopus 로고
    • Analysis of insurance payment denials using the prudent layperson standard
    • Tintinalli J. Analysis of insurance payment denials using the prudent layperson standard. Ann Emerg Med. 2000;35:291-294.
    • (2000) Ann Emerg Med , vol.35 , pp. 291-294
    • Tintinalli, J.1
  • 25
    • 0029610803 scopus 로고
    • The growth of medical groups paid through capitation in California
    • Robinson JC, Casalino LP. The growth of medical groups paid through capitation in California. N Engl J Med. 1995;333:1684-1687.
    • (1995) N Engl J Med , vol.333 , pp. 1684-1687
    • Robinson, J.C.1    Casalino, L.P.2
  • 26
    • 0035407279 scopus 로고    scopus 로고
    • Scale and structure of capitated physician organizations in California
    • Rosenthal MB, Frank RG, Buchanan JL, et al. Scale and structure of capitated physician organizations in California. Health Aff (Millwood). 2001;20:109-119.
    • (2001) Health Aff (Millwood) , vol.20 , pp. 109-119
    • Rosenthal, M.B.1    Frank, R.G.2    Buchanan, J.L.3
  • 28
    • 0035461830 scopus 로고    scopus 로고
    • Managed care and market power: Physician organizations in four markets
    • Rosenthal MB, Landon BE, Huskamp HA. Managed care and market power: physician organizations in four markets. Health Aff (Millwood). 2001;20:187-193.
    • (2001) Health Aff (Millwood) , vol.20 , pp. 187-193
    • Rosenthal, M.B.1    Landon, B.E.2    Huskamp, H.A.3
  • 29
    • 0035286985 scopus 로고    scopus 로고
    • Provider organizations at risk: A profile of major risk-bearing intermediaries, 1999
    • Gold MR, Hurley R, Lake T. Provider organizations at risk: a profile of major risk-bearing intermediaries, 1999. Health Aff (Millwood). 2001;20:175-185.
    • (2001) Health Aff (Millwood) , vol.20 , pp. 175-185
    • Gold, M.R.1    Hurley, R.2    Lake, T.3
  • 32
    • 0036634461 scopus 로고    scopus 로고
    • Patients in conflict with managed care: A profile of enrollee appeals of benefits denials in two HMOs
    • Gresenz CR, Studdert DM, Campbell N, et al. Patients in conflict with managed care: a profile of enrollee appeals of benefits denials in two HMOs. Health Aff (Millwood). 2002;21:189-196.
    • (2002) Health Aff (Millwood) , vol.21 , pp. 189-196
    • Gresenz, C.R.1    Studdert, D.M.2    Campbell, N.3
  • 33
    • 0003518513 scopus 로고
    • Hyattsville, MD: US Department of Health, Education and Welfare. Public Health Service, Office of the Assistant Secretary for Health, National Center for Health Statistics. DHEW publication No. (PHS) 79-1352
    • Schneider D, Appleton L, McLemore T. A Reason for Visit Classification for Ambulatory Care. Hyattsville, MD: US Department of Health, Education and Welfare. Public Health Service, Office of the Assistant Secretary for Health, National Center for Health Statistics; 1979. DHEW publication No. (PHS) 79-1352.
    • (1979) A Reason for Visit Classification for Ambulatory Care
    • Schneider, D.1    Appleton, L.2    McLemore, T.3
  • 34
    • 0037453948 scopus 로고    scopus 로고
    • Consumer protection in managed care: Enrollee appeals of pre-service coverage denials at two HMOs
    • Studdert, DM, Gresenz, CR. Consumer protection in managed care: enrollee appeals of pre-service coverage denials at two HMOs. JAMA. 2003;289:864-870.
    • (2003) JAMA , vol.289 , pp. 864-870
    • Studdert, D.M.1    Gresenz, C.R.2
  • 37
    • 80755186397 scopus 로고
    • Do the poor sue more? A case-control study of malpractice claims and socioeconomic status
    • Burstin HR, Johnson WG, Lipsitz SR, et al. Do the poor sue more? A case-control study of malpractice claims and socioeconomic status. JAMA. 1993;270:1697-1701.
    • (1993) JAMA , vol.270 , pp. 1697-1701
    • Burstin, H.R.1    Johnson, W.G.2    Lipsitz, S.R.3
  • 38
    • 0034146021 scopus 로고    scopus 로고
    • Negligent care and malpractice claiming behavior in Utah and Colorado
    • Studdert DM, Thomas EJ, Burstin HR, et al. Negligent care and malpractice claiming behavior in Utah and Colorado. Med Care. 2000;38:250-260.
    • (2000) Med Care , vol.38 , pp. 250-260
    • Studdert, D.M.1    Thomas, E.J.2    Burstin, H.R.3
  • 39
    • 0035090783 scopus 로고    scopus 로고
    • Effect of ethnicity on denial of authorization for emergency department care by managed care gatekeepers
    • Lowe RA, Chhaya S, Nasci K, et al. Effect of ethnicity on denial of authorization for emergency department care by managed care gatekeepers. Acad Emerg Med. 2001;8:259-266.
    • (2001) Acad Emerg Med , vol.8 , pp. 259-266
    • Lowe, R.A.1    Chhaya, S.2    Nasci, K.3


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