Which of the following describe current legislation acts that limit what managed care organizations (MCOs) are allowed to do? (Select all that apply.)
a. Allowing patients to see a specialist without having to obtain approval from their primary care provider
b. Allowing patients to go to the emergency department without first telephoning for approval
c. Allowing patients the right to choose a physician
d. Requiring the MCO to fulfill expectations of the national patients' rights bill
e. Requiring the MCO to accept any provider who meets plan requirements
f.
Requiring the MCO to accept advanced practice nurses as primary care providers
ANS: A, B, C
In 1999, the House and Senate passed bills that focused on client rights in the managed care environment, but more needs to be done to improve client rights. Client rights issues that are vitally important are information disclosure, physician and provider choice, direct access to specialists, reimbursement for emergency care, and reimbursement denial. As has been discussed, there is still no national patients' bill of rights.
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