Forum Session

ERISA Health Plan Denials: Exploring Models for External Review
June 19, 1998


Karl Polzer


With federal policymakers facing a complex set of proposals to bolster consumer protections available to the 125 million people in private-sector employee health plans, this Forum session explored the experience of two existing models for reviewing managed care plan decisions, one used by the Medicare program and another by the state of Florida. Also taking into account what other states have done, the meeting explored key issues facing federal policymakers attempting to reconstruct and integrate the elements of the grievance, appeals, and legal processes available to consumers under the Employee Retirement Income Security Act of 1974 (ERISA), which governs about 2.5 million private-sector employee health plans.


Geraldine Dallek, Project Director, Institute for Health Care Research and Policy, Georgetown University; Pamela Poulin, Assistant General Counsel, Office of the General Counsel, Florida Agency for Health Care Administration; David A. Richardson, Jr., President, Center for Health Dispute Resolution, Pittsford, NY

Related Materials

More information available in the accompanying publication, Issue Brief No. 720.

See also "Emerging Issues in the Use of Binding Arbitration to Resolve Disputes Between Individuals and Health Plans" (Background Paper, November 2000).

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