Deborah R. Hensler

Brooks Rand, Seattle, Washington, United States

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Publications (6)9.28 Total impact

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    ABSTRACT: Despite speculation about the nature of disputes between managed care enrollees and their health plans over benefit denials, little empirical information exists about the details of such disputes and how they are actually handled. In this study we profile more than 11,000 appeals lodged between 1998 and 2000 by enrollees at two of the nation's largest health maintenance organizations (HMOs), to shed some preliminary light on the vast terrain of enrollee appeals. As many as half of appeals involved requests for reimbursement for costs of services already obtained ("retrospective" appeals), as opposed to services sought ("prospective appeals"). Enrollees won 36 percent of prospective appeals at Plan 1 and 70 percent at Plan 2, compared with 89 percent and 78 percent, respectively, of retrospective appeals. The success rate among retrospective appeals involving emergency room services--95 percent at both plans--was particularly striking.
    Health Affairs 01/2002; 21(4):189-96. · 4.64 Impact Factor
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    Thomas D. Rowe Jr, Deborah R. Hensler
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    ABSTRACT: Abstract not available
    Faculty Scholarship. 01/2001;
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    ABSTRACT: Policymakers are considering legislative changes that would increase managed care organizations' exposure to civil liability for withholding coverage or failing to deliver needed care. Using a combination of empirical information and theoretical analysis, we assess the likely responses of health plans and Employee Retirement Income Security Act (ERISA) plan sponsors to an expansion of liability, and we evaluate the policy impact of those moves. We conclude that the direct costs of liability are uncertain but that the prospect of litigation may have other important effects on coverage decision making, information exchange, risk contracting, and the extent of employers' involvement in health coverage.
    Health Affairs 01/1999; 18(6):7-27. · 4.64 Impact Factor
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    ABSTRACT: Policymakers are considering legislative changes that would increase the exposure of managed care organizations to civil litigation for withholding coverage or failing to deliver needed care. Using a combination of empirical information and theoretical analysis, we assess the likely responses of health plans and ERISA plan sponsors to an expansion of liability, and evaluate the policy impact of those moves. We conclude that the direct costs of liability are uncertain, but that the threat of litigation may have other important effects on coverage decision-making, information exchange, risk contracting, and the willingness of employers to continue active involvement in health coverage. Before legislators turn up the legal heat on managed care organizations, they should carefully consider the broader implications of global warming in the health care system.
    01/1999;
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    ABSTRACT: PROLOGUE: Unlike most other industrialized nations, which compel employers to contribute to, if not cover the entire cost of, health insurance, the U.S. employer-based system is voluntary. Neither federal nor state laws require employers (except in Hawaii) to finance insurance coverage for employees and their families. Under this voluntary approach a large (64 percent in 1996) but declining number of all nonelderly Americans receive health benefits through the workplace. But what happens if the federal government, through legislated policies, upsets the balance of interests that persuade most large, if not all small and medium-size, employers to offer their employees health insurance? In this penetrating paper David Studdert and three colleagues examine this question in the context of the intense congressional debate over whether patients should be allowed to sue managed care companies. Studdert holds advanced degrees in law (University of Melbourne, Australia), health policy, and public health (both from Harvard University). He is a policy analyst at RAND and worked previously as an attorney and as an adviser to the health minister in Australia. William Sage, a physician and an attorney (both degrees from Stanford University), is an associate professor of law at Columbia University. Carole Gresenz holds a doctorate in economics from Brown University and works as a health and labor economist at RAND. Deborah Hensler is a professor of law at Stanford University and a senior fellow at the RAND Institute for Civil Justice.
  • Linda J. Demaine, Deborah R. Hensler
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    ABSTRACT: This article helps build the empirical foundation necessary for an informed debate regarding arbitration clauses in consumer contracts by providing preliminary insight into how businesses' use of these clauses affects consumers' ability to pursue their legal rights. To this end, the article reports the results of a study investigating, in a wide variety of consumer purchases, the frequency with which the average consumer encounters arbitration clauses, the key provisions of these clauses, and the implications of these clauses for consumers who subsequently have disputes with businesses they patronize.

Publication Stats

31 Citations
108 Views
9.28 Total Impact Points

Top Journals

Institutions

  • 2002
    • Brooks Rand
      Seattle, Washington, United States
  • 1999
    • Columbia University
      New York City, New York, United States