Deborah R. Hensler

Publications (3)4.31 Total impact

• Article: Expanding Managed Care Liability: What Impact on Employment-based Health Coverage?

  David M. Studdert, William M. Sage, Carole R. Gresenz, Deborah R. Hensler
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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.
  Columbia Law School, Law & Economics Research Paper Series. 12/1999;
• Source

  Available from: SSRN

  Article: Beyond It Just Ain't Worth It: Alternative Strategies for Damage Class Action Reform

  Thomas D. Rowe Jr, Deborah R. Hensler
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  ABSTRACT: Abstract not available
  Faculty Scholarship.
• Article: Patients in conflict with managed care: a profile of appeals in two HMOs.

  Carole Roan Gresenz, David M Studdert, Nancy Campbell, Deborah R Hensler
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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 21(4):189-96. · 4.31 Impact Factor