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MANAGED CARE June 2003. ©MediMedia USA

TRENDS

Effectiveness of review process in eye of beholder

California legislators passed the Friedman-Knowles Act of 1998 to, according to the California HealthCare Foundation, require HMOs to "provide external and independent medical review for specific classes of patients who requested investigational or experimental treatments that were denied by their health plan."

From January 1999 to December 2000, 263 independent medical reviews were conducted in California as a result of patients trying to overturn coverage decisions by health plans. The Institute of Medical Quality, on behalf of the foundation, surveyed those patients to obtain their opinions regarding the effectiveness of the review process.

Perhaps not surprisingly, patients' views of the process differed according to whether their requests had been approved or denied.

To what extent has the independent medical review process increased people's trust in their health plans?

How confident are you that the patient's specific medical issues were considered?

How confident are you that the medical experts conducted a fair and impartial review?

How confident are you that the medical experts thoroughly considered available scientific information?

SOURCE: PREPARED FOR THE CALIFORNIA HEALTHCARE FOUNDATION BY THE INSTITUTE FOR MEDICAL QUALITY, 2003