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HMO: Let MDs Decide "Medically Necessary"  LIST.HEALTHPLAN
 Nov 08, 1999 09:47 PST 
Full report is at:

Large HMO to let doctors have the final say

November 8, 1999 Web posted at: 9:50 AM EST (1450 GMT)

Associated Press reports that UnitedHealth Group, the
nation's second largest health insurer, plans to give
doctors, not administrators, the final say on what
treatments are medically necessary.

UnitedHealth, which covers 14.5 million people across
the country, paid more money to scrutinize and deny
questionable treatments than the practice saved,
according to Dr. Archelle Georgiou, the Minneapolis-
based company's chief medical officer.

Officials said UnitedHealth will announce Tuesday that
it will grant doctors decision-making ability on their
patients' treatments, even if the insurer's staffers
believe such services aren't medically necessary.

Some experts, terming the company's planned move a
historic one in managed care, expect other insurers to
do likewise because of industry pressure.

"It's just extraordinary. Here they are saying that
there are other ways to save money without rationing
care," Robert Blendon, a Harvard University professor of
health policy, told The Dallas Morning News. "It removes
a fundamental tenet of how these plans have been
operating in order to be cost-effective."

Georgiou said UnitedHealth approved 99 percent of
requests, so the process was unnecessary.

"Within UnitedHealth care, we were spending $100 million
a year nationally to say yes," she said. "Yet, it was
the root cause of many of the negative perceptions of
managed care."

Insurers are now placing more trust in their physicians
by reducing the number of procedures requiring pre-
approval, according to the American Association of
Health Plans. The industry trade group has surveyed the
top 25 managed care companies to assess how they handle
treatments doctors recommend.
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