Using Arbitration to Resolve Disputes between Individuals and Health Plans: Issues for Federal Policymakers
December 1, 2000
As Congress continued struggling with how to resolve differences over patient protection legislation, this session explored the use of binding arbitration and other methods of alternative-dispute resolution in the health care field, along with potential for abuse of such methods. Particular attention was paid to disputes that arise between individuals and large organizations engaged in the provision of benefits, insurance, and medical services. Speakers and panelists included representatives of the arbitration profession and of several types of health plans that regularly use arbitration as well as researchers and interest groups. A senior official of the U.S. Department of Labor also presented the department's new regulations governing internal appeals of denied health and disability claims under the Employee Retirement Income Security Act of 1974 (ERISA), including how arbitration might be used. A group of senior Capitol Hill and executive branch staff then engaged in a discussion with the invited experts and explored topics including how experiences with arbitration might inform legislative efforts to develop an external review system for disputed medical claims and to retool the court remedies available under ERISA.
Robert E. Meade, Senior Vice President, American Arbitration Association; Max Zimny, General Counsel, Union of Needletrades, Industrial and Textile Employees, New York; William L. Bedman, Assistant General Counsel, Halliburton Law Department, Employment Practice Group; Elizabeth Rolph, Senior Political Scientist, RAND; Sharon Lybeck Hartmann, Law Offices of Sharon Lybeck Hartmann; Leslie B. Kramerich, Acting Assistant Secretary, Pension and Welfare Benefits Administration, U.S. Department of Labor; Mich'l Hawkins, Legislative Representative, Kaiser Foundation Health Plan, Inc.; Phyllis C. Borzi, Research Professor, Center for Health Services Research and Policy, George Washington University Medical Center; Joanne L. Hustead, Director of Legal and Public Policy, National Partnership for Women and Families; J. Warren Wood III, Vice President, General Counsel, and Secretary, Robert Wood Johnson Foundation
More information available in the accompanying Background Paper.
See also ERISA Health Plan Denials: Exploring Models for External Review (Issue Brief 720, June 19, 1998).