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Unformatted text preview: Retrospective Utilization Review : pt has already received tx, so worst that can happen is someone loses money Prospective Utilization Review : now fight over access to care STATE LAWS : Insurance companies have to promptly pay claims in good faith. -->Allow for recovery of damages in excess of claims In US: pensions come from private employers Employment Retirement Income (aka Pension) Security Act : also regulated employee benefit plans (fringe benefits --> including health insurance) Problem: for big employers in several states, diff laws in every state--> ERISA super cedes state laws for employers with employees in multiple states Private Cause of Action : provided to employee if employer violates ERISA --> sue in fed court--> Court does well with cases where it decides who should receive money Prospective Utilization Review : insurance decides to deny tx an pt dies --> all family can get...
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This note was uploaded on 04/05/2008 for the course HPAA 310 taught by Professor Deanharris during the Fall '07 term at UNC.
- Fall '07