Medicare Managed Care Appeal Process for Denials of Care: A Comparison With Recommendations From the President's Quality Commission

Pursuant to a congressional request, GAO reviewed information on Medicare managed care appeals to help Congress consider legislation on national appeal rights for private-sector health care consumers, focusing on: (1) comparing the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry's recommended appeal process with that required by the Medicare program; and (2) describing the appeals reviewed by Medicare's external appeals contractor, the Center for Health Dispute Resolution (CHDR).