To Your Health: Your Consumer Rights in Managed Care can be accessed from the links below in RealAudio® format, as well as in an online web page version.

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• Understanding the basics of managed care.
• Recognizing the different types of managed care plans.
• Using your health care plan to your advantage.
• Knowing your rights as a member of a managed care plan.
• Appealing a decision of your managed care plan.
• Reaching out to appropriate resources for assistance.

1. SPONSORS
2. INTRODUCTION
3. EASY GUIDE
   • Questions & Answers - An Easy Guide to the Consumer Rights in Managed Care Handbook
4. WHAT IS MANAGED HEALTH CARE
   • Defining Managed Care
5. TYPES OF MANAGED CARE PLANS
   • What Health Services Are Covered By Your Plan?
   • What Type of Managed Care Plan Do You Have?
     1. HMOs - Health Maintenance Organizations
     2. POSs - Point of Service Plans
     3. PPOs - Preferred Provider Organizations
     4. Medicare HMOs
     5. Medicaid HMOs - New Jersey Care 2000+
     6. New Jersey KidCare
     7. Charity Care
   • Laws to Help You Keep Employer-Sponsored Health Care Coverage
     1. COBRA
     2. HIPAA
6. Part I:  MAKING MANAGED CARE WORK FOR YOU and
7. Part II:  MAKING MANAGED CARE WORK FOR YOU
   • Tips for Working with Your Managed Care Plan
   • How to Use Your Health Care Plan
   • How to Get General Health Care from Your Managed Care Plan
   • Self-Help Tips in Working with Your Health Plan
   • An Overview of Private or Employer-Provided Insurance
   • An Overview of Public Health Care Programs
8. Part I:  YOUR LEGAL RIGHTS IN A MANAGED CARE PLAN and
9. Part II:  YOUR LEGAL RIGHTS IN A MANAGED CARE PLAN
   • Your Legal Rights in New Jersey
   • Commercial Insurance
   • The Grievance and Appeals Process for Commercial Insurance
   • How to Deal with Quality of Care Issues - Filing a Grievance
   • How to Deal with a Denial, Termination, or Limitation of Covered Health
   • Services - Filing an Appeal
   • Medicaid Managed Care
     1. Your Complaint, Grievance, and Appeal Rights
     2. Filing a Grievance / Appeal with Your Plan
     3. You Have a Due Process Right to a Fair Hearing
   • Medicare Managed Care
     1. Thinking About Medicare Managed Care
     2. Medicare Grievance and Appeal Rights
     3. Filing a Grievance Under Medicare Managed Care
     4. How to File an Appeal Under Medicare Managed Care
        1. Appeals on an Emergency Basis
     5. Filing for a PRO Review if You are Denied Coverage for Inpatient Hospital Care
10. APPEAL TIPS
    • Tips to Increase Your Chances of a Successful Appeal
    • If Your Appeal is Unsuccessful, What to do Next
11. GLOSSARY
12. Part I:  SAMPLES (PHONE CALLS AND LETTERS) and
13. Part II:  SAMPLES (PHONE CALLS AND LETTERS)
    • A Recordkeeping Checklist
    • Commercial Insurance / Grievance on Quality of Care
    • Commercial Insurance / Stage 1 - Informal Appeal
    • Commercial Insurance / Stage 2 - Formal Internal Appeal
    • Commercial Insurance / Stage 3 - External Appeal
    • Medicare / Grievance Phone Call
    • Medicare / Step 1 - Appeal
    • Medicaid / Grievance on Quality of Care
    • Medicaid / Grievance on Denial of Health Services
    • Log Sheet
14. RESOURCE GUIDE
    • Advocacy Organizations
    • Government Departments
    • Legal Help
    • Insurance-Related Organizations
15. ADDENDA
    • Mental Health and Substance Abuse Services
    • Managed Care and the Disability Community