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Health
PND Connections - Closer Look at External Medical Review Processes of California Health Plans
Most health plans have internal review processes through which members can appeal denials of care or coverage. A new report from the Institute for Medical Quality and the California Healthcare Foundation details a two-part study to assess whether California's mandated external review process has met key goals and suggests ways to make the process more effective. The report, Independent Medical Review Experiences in California, Phase I, II (146 pages, PDF), reviews program outcomes, compiles opinions and suggestions from consumers, and offers recommendations from physicians, regulators, consumers, and health plan officials.
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