What care should be covered?

: The answer to the question of what health care services should be covered by a managed care plan is straightforward; the plan should cover whatever the consumer is willing to pay for. From the plan's perspective, the consumer is the payer, that is, the employer who negotiates the plan; not the individual patient whose personal preferences and interests may be quite different. Since managed care organizations contract with payers to arrange for health care services within a defined set of benefits, there is a broader question as well: Within the benefits chosen by the payer, what actually is covered? Criteria for determining "medical necessity," which managed care plans frequently use as the basis for coverage, are discussed
Keywords No keywords specified (fix it)
Categories (categorize this paper)
DOI 10.1353/ken.1997.0035
 Save to my reading list
Follow the author(s)
My bibliography
Export citation
Find it on Scholar
Edit this record
Mark as duplicate
Revision history
Request removal from index
Download options
Our Archive

Upload a copy of this paper     Check publisher's policy     Papers currently archived: 27,157
External links

Setup an account with your affiliations in order to access resources via your University's proxy server
Configure custom proxy (use this if your affiliation does not provide a proxy)
Through your library
References found in this work BETA

No references found.

Add more references

Citations of this work BETA
The Concept of Underinsurance: A General Typology.Andrew Ward - 2006 - Journal of Medicine and Philosophy 31 (5):499 – 531.

Add more citations

Similar books and articles

Monthly downloads

Added to index


Total downloads

8 ( #488,880 of 2,163,655 )

Recent downloads (6 months)

1 ( #348,043 of 2,163,655 )

How can I increase my downloads?

My notes
Sign in to use this feature

There  are no threads in this forum
Nothing in this forum yet.

Other forums