Lack of Action On Appeals Law Puzzles Texans

Texas officials are not sure what to make of a lack of interest in a state law governing appeals of denial of care. The statute allows health plan enrollees to petition an independent state commission for review of denials after they have exhausted their insurers' internal appeals processes. Since the law giving Texans that right passed last summer, however, only 16 cases have been put before the state — far fewer than the 4,000 requests it expected during the first year.

Health plans have an answer. They say the fact that little has happened is testament to their efforts to improve appeals processes. Texas Medical Association executives, too, think many plans have changed their procedures, but to avoid the expense of external review. Still, the state's HMO industry is challenging the law in court.

The legislature passed the bill after a number of patients testified about having been denied medical care. Texas is one of only nine states to mandate external review. Because most managed care reform plans in Washington include provisions for external review, the industry is watching Texas carefully. To date, the commission has upheld insurer denials six times and overturned eight others. Two are pending.

Career Opportunities

HAP, a subsidiary of Henry Ford Health System, is a nonprofit health plan providing coverage to individuals, companies and organizations. This executive develops strategies to meet membership and revenue targets through products, pricing, market segmentation and advertising.  Aligns business among Business Development, Commercial Sales, Medicare and Public Sector Programs and Product Development. Seeks to enhance and be responsible for business development and expansion through the development of an effective product portfolio, strong interpersonal relationships and service excellence.

Apply via email to or online at

Subscribe to Our Newsletters

Monthly table of contents

Be notified as each issue of Managed Care is available online.

Biweekly newsletter

Recent topics have included:

PTCommunity news

New drug approvals, clinical trials, drug management. Three times per week.