State mandates expand for external review, direct access


Nine states passed mandates in 1998 for external review of coverage denials. Five states' new laws allow enrollees to appeal denials of coverage for both medically necessary procedures and investigational treatments. Also last year, nine states enacted direct-access laws, giving members of "gatekeeper" plans the right seek treatment from — depending on the state — chiropractors, ophthalmologists, dermatologists, and/or other practitioners. In 1998, more than half of the state legislatures debated HMO liability bills, but none passed.


SOURCE: BLUE CROSS BLUE SHIELD ASSOCIATION, WASHINGTON, 1999

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 jfedder1@hfhs.org or online at http://p.rfer.us/HENRYFORDlXqAJA

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