External Review

A strong grievance and appeals process that includes the right to an external review—a review by an independent party—allows patients the ability to challenge limits on services. The Report Card examines whether state policy supports a patient’s right to challenge denial of care claims.

  • External Review

      Strength Of Policy 2007 Change From 2004
    ALABAMA Meets Policy Better
    ALASKA Meets Policy Same
    ARIZONA Meets Policy Same
    ARKANSAS Meets Policy Same
    CALIFORNIA Meets Policy Same
    COLORADO Meets Policy Same
    CONNECTICUT Meets Policy Same
    DELAWARE Meets Policy Same
    DISTRICT OF COLUMBIA Meets Policy Same
    FLORIDA Meets Policy Same
    GEORGIA Meets Policy Same
    HAWAII Meets Policy Same
    IDAHO No/Harmful Policy Same
    ILLINOIS Meets Policy Same
    INDIANA Meets Policy Same
    IOWA Meets Policy Same
    KANSAS Meets Policy Same
    KENTUCKY Meets Policy Same
    LOUISIANA Meets Policy Same
    MAINE Meets Policy Same
    MARYLAND Meets Policy Same
    MASSACHUSETTS Meets Policy Same
    MICHIGAN Meets Policy Same
    MINNESOTA Meets Policy Same
    MISSISSIPPI No/Harmful Policy Same
    MISSOURI Meets Policy Same
    MONTANA Meets Policy Same
    NEBRASKA No/Harmful Policy Same
    NEVADA Meets Policy Same
    NEW HAMPSHIRE Meets Policy Same
    NEW JERSEY Meets Policy Same
    NEW MEXICO Meets Policy Same
    NEW YORK Meets Policy Same
    NORTH CAROLINA Meets Policy Same
    NORTH DAKOTA Meets Policy Better
    OHIO Meets Policy Same
    OKLAHOMA Meets Policy Same
    OREGON Meets Policy Same
    PENNSYLVANIA Meets Policy Same
    RHODE ISLAND Meets Policy Same
    SOUTH CAROLINA Meets Policy Same
    SOUTH DAKOTA No/Harmful Policy Same
    TENNESSEE Meets Policy Same
    TEXAS Meets Policy Same
    UTAH Meets Policy Same
    VERMONT Meets Policy Same
    VIRGINIA Meets Policy Same
    WASHINGTON Meets Policy Same
    WEST VIRGINIA Meets Policy Same
    WISCONSIN Meets Policy Same
    WYOMING No/Harmful Policy Same
     
    Meets PolicyMeets Policy 46  
    Limited PolicyLimited Policy 0  
    Weak PolicyWeak Policy 0  
    No/Harmful PolicyNo/Harmful Policy 5  
    Better Better 2  
    Worse Worse 0  
    Same Same 49  

    Does the state require managed care programs to provide patients with a right to external review of the managed care company’s decisions?

    States receive a "meets policy" if they require managed care organizations to have an external review procedure. States receive a "no policy" if they have no such requirement.

    Data Source: External Review, 2006.

    The Henry J. Kaiser Family Foundation,  "Patients' Rights: External Review, 2006," available at http://www.statehealthfacts.org/comparetable.jsp?ind=361&cat=7, accessed May 22, 2007.