RT Journal Article
SR Electronic
T1 Managed care and ERISA: synopsis and case law review
JF Journal of the American Academy of Psychiatry and the Law Online
JO J Am Acad Psychiatry Law
FD American Academy of Psychiatry and the Law
SP 364
OP 371
VO 31
IS 3
A1 Gerbasi, JB
YR 2003
UL http://jaapl.org/content/31/3/364.abstract
AB Managed care organizations (MCOs) have become the predominant health care model in the United States. Through cost containment arrangements with providers, incentives for patients to pursue less costly care and reductions in the provision of unnecessary care, MCOs are more intimately involved in the delivery of health care than their former fee-for-service insurance company counterparts. However, this new role has not implied increased liability, largely because of The Employee Retirement Income Security Act of 1974 (ERISA). This article provides an overview of ERISA and a review of the important legal cases in this area, including the three most recent Supreme Court cases. Courts have struggled with interpreting ERISA, and decisions have been difficult to reconcile. Frustration with this statute and the failure of the U.S. Congress to amend it, has led to more liberal interpretations of ERISA in recent years.