Health Insurance/Costs: Consumer Protections

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A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan
Helps consumers navigate their employer or private health plan's internal grievance procedure and external review programs of specific states.

How Private Health Coverage Works: A Primer -- 2008
This primer explains the role and operations of private health coverage in the United States. It discusses the fundamental aims of private coverage and sorts out the complicated web of state and federal regulations that govern it.

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How Private Health Coverage Works: A Primer – 2008 Update -- April 2008
This primer explains the role and operations of private health coverage in the United States. It discusses the fundamental aims of private coverage and sorts out the complicated web of state and federal regulations that govern it.

Health Affairs Article: Impact of State Tort Reforms on Physician Malpractice Payments -- March 2007
A study in the March/April 2007 issue of Health Affairs analyzes the impact of state tort reforms on physician malpractice claims. The study finds that the tort law changes have had a measurable but limited impact on physician malpractice claims, depending on the type and strength of the tort reform.

Spotlight: The Public, Managed Care, and Consumer Protections -- January 2006
Kaiser Public Opinion Spotlight: The Public, Managed Care, and Consumer Protections

A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan, Update -- August 2005
Helps consumers navigate their employer or private health plan's internal grievance procedure and external review programs of specific states.

Current Trends and Future Outlook for Retiree Health Benefits: Chartpack from the Kaiser/Hewitt 2004 Survey on Retiree Health Benefits -- December 2004
This chartpack provides key findings from the survey assessing retiree health benefits.

National Survey on Consumers' Experiences With Patient Safety and Quality Information -- Summary and Chartpack -- November 2004
This chartpack summarizes key findings from a national survey assessing Americans' perceptions about the quality of health care, their awareness and reported usage of information in making their health care choices, and their experiences with their health care providers five years after the Institute of Medicine's landmark report on medical errors.

National Survey on Consumers' Experiences With Patient Safety and Quality Information -- Toplines -- November 2004
This document includes the complete toplines from a national survey assessing Americans' perceptions about the quality of health care, their awareness and reported usage of information in making their health care choices, and their experiences with their health care providers five years after the Institute of Medicine's landmark report on medical errors.

Medical Liability Reforms: Comparison of the Candidates' Proposals -- October 2004
Medical Liability Reforms: Comparison of the Candidates' Proposals

Health Care and the 2004 Elections: Medical Liability Reform -- October 2004
Sharp increases in medical liability insurance premiums in recent years, and the withdrawal of some insurers from this market have focused the attention of health care providers, patients, and policymakers on reform of the medical liability system. Of additional concern is that the fear of liability causes physicians to practice medicine in ways that raise costs. There are varying opinions of how medical liability reform should be addressed, including whether it should remain a state issue or be addressed at the federal level, and, if so, how.

Marketing and Privacy Issues: An Analysis of the MMA and Proposed Regulations -- September 2004
This paper looks at issues related to the new Medicare prescription drug benefit with regard to drug plan marketing activities and privacy issues.

This primer explains the role and operations of private health coverage in the United States. It discusses the fundamental aims of private coverage and sorts out the complicated web of state and federal regulations that govern it.

A study in the March/April 2007 issue of Health Affairs analyzes the impact of state tort reforms on physician malpractice claims. The study finds that the tort law changes have had a measurable but limited impact on physician malpractice claims, depending on the type and strength of the tort reform.

Kaiser Public Opinion Spotlight: The Public, Managed Care, and Consumer Protections

Helps consumers navigate their employer or private health plan's internal grievance procedure and external review programs of specific states.

This chartpack provides key findings from the survey assessing retiree health benefits.

This chartpack summarizes key findings from a national survey assessing Americans' perceptions about the quality of health care, their awareness and reported usage of information in making their health care choices, and their experiences with their health care providers five years after the Institute of Medicine's landmark report on medical errors.

This document includes the complete toplines from a national survey assessing Americans' perceptions about the quality of health care, their awareness and reported usage of information in making their health care choices, and their experiences with their health care providers five years after the Institute of Medicine's landmark report on medical errors.

Medical Liability Reforms: Comparison of the Candidates' Proposals

Sharp increases in medical liability insurance premiums in recent years, and the withdrawal of some insurers from this market have focused the attention of health care providers, patients, and policymakers on reform of the medical liability system. Of additional concern is that the fear of liability causes physicians to practice medicine in ways that raise costs. There are varying opinions of how medical liability reform should be addressed, including whether it should remain a state issue or be addressed at the federal level, and, if so, how.

This paper looks at issues related to the new Medicare prescription drug benefit with regard to drug plan marketing activities and privacy issues.

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Health Insurance/Costs: Consumer Protections

Most people now get their health care through some form of managed care plan – a health maintenance organization (HMO), preferred provider organization (PPO), or point-of-service option (POS). And most of the time these people receive the care they need. But when a health plan decides that the care a patient or their doctor wants is not medically necessary, or limits the care in some way, or denies payment for the care, the potential for a dispute with the plan arises. The health plan may be justified in refusing to provide or pay for treatment if it is generally not considered medically necessary, or not necessary in the particular situation, or not covered by the policy. The cases most likely to end up in dispute are often not clear-cut, such as treatments that may be new and experimental, whose value is unproven.

Consumers have certain rights under state and federal laws that they can exercise if they disagree with a decision their plan makes about medical coverage. These rights apply to both the “internal review” process and “external review.” The rights depend on the type of health plan the person has and which state they live in.