South Med J. 2004 Mar;97(3):284-6.

Utilization review and managed health care liability.

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Middleberg, Riddle & Gianna, New Orleans, LA 70170, USA. rspector@midrid.com

Abstract

This article explores the development of jurisprudence interpreting application of the Employee Retirement Income Security Act of 1974 to patient care denials by managed care. It identifies quality-of-care protections for patient care under present federal law. If an insurance company utilization review denies care based on patient-specific reasoning, then the patient may have recourse against the utilization review on the basis of a state law claim of malpractice grounded in medical decision-making by the insurance company.

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Utilization review and managed health care liability.

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