What Care Should Be Covered?
Mansheim, Bernard J.
Kennedy Institute of Ethics Journal. 1997 Dec; 7(4): 331-336.
The answer to the question of what health care services should be covered by a managed care plan is straightforward; the plan should cover whatever the consumer is willing to pay for. From the plan's perspective, the consumer is the payer, that is, the employer who negotiates the plan; not the individual patient whose personal preferences and interests may be quite different. Since managed care organizations contract with payers to arrange for health care services within a defined set of benefits, there is a broader question as well: Within the benefits chosen by the payer, what actually is covered? Criteria for determining "medical necessity," which managed care plans frequently use as the basis for coverage, are discussed.
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Mansheim, Bernard J. (1997-12)
Culver, Charles M.; Gert, Bernard (2001-09)
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