Updated Consumer Guide Explains How to Resolve Problems with Managed Care Plans

Guide Includes Information about Health Plan Internal Dispute Resolution and External Review Programs in 43 States and D.C.

Washington, D.C. – The Kaiser Family Foundation and Consumers Union today released an updated guide to help consumers through the process of resolving disputes with their health plans. The resource, A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan, 2005 Update, includes information about how consumers can take advantage of their health plans' internal processes to resolve disputes, as well as external review processes as allowed under state laws.

The vast majority of Americans now receive their health coverage from Preferred Provider Organizations, Health Maintenance Organizations, or other types of managed care plans. This guide can help consumers to understand their coverage under these plans, their rights under the governmental rules that health plans must follow, and the role that state external review programs play in resolving disputes.

“Problems with health plans often arise during the course of a health crisis, making it especially difficult for consumers to resolve these issues successfully,” Kaiser Family Foundation president Drew E. Altman said. “This guide provides valuable information to help people navigate what is often a confusing health insurance system.”

The guide includes state-by-state details on the external review programs in the 43 states and the District of Columbia that have such programs, including Arkansas and Nevada which implemented programs after the 2003 version of this guide was issued. ...

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The Kaiser Family Foundation

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