"Gag rules" are intended to prevent physicians from informing patients about services that may be appropriate to their medical condition but are not offered or covered by their managed care organization
. They prevent patients from knowing what services the managed care organization
covers and, therefore, why it has not covered the specific service that may be appropriate to their disease.
A managed care organization
should pay for medical costs, not real estate, paper clips or executive junkets.
"Some companies assume that once they make a commitment to a managed care organization
, their role is over," Ms.
Most managed care organizations
in Medicaid use a "gatekeeper" to manage healthcare of individuals.
Managed care organizations
, rather than writing policies, maintain a network of health providers and oversee the insurance process to ensure lower medical costs and reduced premiums, she says.
This book is an excellent text for an undergraduate or master's course dealing with managed care organizations
or a comprehensive reference for researchers, planners, or health care professionals seeking to examine HMOs, PPOs, and CMPs as alternative ways to finance and deliver health care.
A by-product of ERISA has been the protection granted to insurance companies, employers, and managed care organizations
against lawsuits based on their administration of health plans.
Provider networks, joint ventures, and managed care organizations
must also be scrutinized from a fiduciary perspective.
Although, more recently, long-term care providers have been gaining experience in contracting with traditional managed care organizations
, they have been frustrated by the limited scope of the long-term care benefits offered.
"That relationship is between the physician and the managed care organization
Assuming that a physician runs a quality practice and that the managed care organization
is negotiating fairly the two can meet in a deal that will benefit both and, ultimately patients as well.
This means that it negotiates with a managed care organization
on behalf of one of its 61 subacute or skilled nursing facility members on a contract which the organization is then free to accept or reject.