Managed Care Organizations

Managed Care Organizations

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learned about the liability of MCOs (managed care organizations) such as HMOs (health maintenance organizations) and PPOs (preferred provider organizations).

Thinking about the information in Chapter 6, where does the liability lie for the managed care organization when the MCO personnel make decisions about insurance
coverage for hospital stays?

do not limit your analysis to length of stay, but consider other scenarios associated with MCO decision making such as approval or denial of medically necessary
treatment (or limitations of treatment) as well, and share your scenarios with the class. Defend your response thoroughly and include the potential liability
implications. Lastly, discuss the options, if any, MCO or PPO plan members have when denied coverage for medically necessary care.

Title: Law of Health Administration
Edition: 7th (2014)
Author: Showalter
Publisher: Health Administration Press
Book ISBN: 978-1-56793-644-5

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