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Editorial
February 19, 2003

Managed Care and Patients' Rights

Author Affiliations

Author Affiliations: Hirsch Health Law and Policy Program, The George Washington University School of Public Health and Health Sciences, Washington, DC.

JAMA. 2003;289(7):906-907. doi:10.1001/jama.289.7.906

The article by Studdert and Gresenz1 in this issue of THE JOURNAL is a valuable contribution to the debate about US managed care policy and patients' rights. The analysis of enrollee appeals from 2 California-based health maintenance organizations (HMOs) provides an important look inside the "black box" of prospective coverage decision making, which typically remains hidden from view in the absence of judicial appeal or the very occasional government study. Judicial review of prospective coverage decisions is rare because of the cost and complexity of litigation. Even retrospective appeals are unusual, given the inability in most health insurance disputes to recover damages for death or injuries caused by wrongful denial of benefits by group health plans,2 a limitation that reduces the economic feasibility of litigation.

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