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Related Experiment Videos

Legal liability and managed care

P S Appelbaum1

  • 1Department of Psychiatry, University of Massachusetts Medical Center, Worcester 01655.

The American Psychologist
|March 1, 1993
PubMed
Summary
This summary is machine-generated.

Health insurers use managed care to lower mental health treatment costs, creating new legal duties for clinicians and insurers. This evolving area of law impacts patient access and provider responsibilities.

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Area of Science:

  • Health Law
  • Mental Healthcare Policy

Background:

  • Health insurers are implementing managed care strategies to control mental health treatment expenses.
  • These managed care approaches introduce complex legal considerations for both healthcare providers and insurance entities.

Purpose of the Study:

  • To examine the legal implications and evolving duties of clinicians and managed care organizations under new oversight mechanisms.
  • To outline the potential liabilities and responsibilities arising from managed care in mental health treatment.

Main Methods:

  • Analysis of legal duties and potential liabilities within the context of managed care for mental health.
  • Review of emerging legal standards and case law impacting clinicians and managed care entities.

Main Results:

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  • Clinicians may face duties to appeal denials, disclose managed care impacts, and continue treatment post-denial.
  • Managed care entities have duties regarding reasonable review, disclosure of limitations, and provider selection.

Conclusions:

  • The legal landscape governing managed care in mental health is still developing.
  • Both clinicians and managed care entities must navigate new legal obligations and potential liabilities.