ERISA Medical Necessity DecisionsThe resource you have requested is available only to current members.
ERISA, the federal law which governs most employer-sponsored group health plans, has a number of protections directly related to appeal review. Among the most important to medical necessity appeals, ERISA requires expert review of any denial involving medical judgment. Unfortunately, while carriers often extend expert review to patient appeals, provider appeals often do not automatically garner a high quality, expert review process. . . .. . . . (to read the remainder of this article, please log in below.)
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