New York's highest court of appeals has held that no-fault insurers cannot deny no-fault benefits where they unilaterally determine that a provider has committed misconduct based upon alleged fraudulent conduct. The Court held that this authority belongs solely to state regulators, specifically New York's Board of Regents, which oversees professional licensing and discipline. This follows a similar recent ruling in Florida reported in this publication.
The Trouble with Managed Care
When comparing different types of health care programs, one must always consider how "patient friendly" it is. A recent comparative survey found these discrepancies between Fee for Service and Managed Care:
| Complaint | Fee for Service | Managed Care |
| Not getting treatment you and your doctor thought was necessary | 13% | 22% |
| Unable to see specialist when needed one in past year | 15% | 21% |
| Unable to get needed diagnostic tests in past year | 17% | 24% |
| Care not appropriate or correct for situation | 5% | 12% |
| Not able to get appointment without waiting a long time | 7% | 17% |
| Not able to see doctor without waiting a long time at office | 18% | 26% |
| Doctor did not explain what he/she was doing | 6% | 12% |
| Doctor did not tell when and how to take medications at home | 4% | 10% |
Until managed care becomes more patient friendly, it won't be the health care provider of choice for most patients.
SOURCE: Survey conducted by The Robert Wood Johnson Foundation