Managed Care Law Law and Legal Definition
Managed care is a general term for a medical plan that aims to ensure that the treatments a person receives are medically necessary and provided in a cost-effective manner. It is a system of health-care delivery that aims to control costs by assigning set fees for services, monitoring the need for procedures such as tests and surgical operations, and stressing preventive care.
Some types of managed health-care systems include health maintenance organizations HMOs), preferred provider organizations (PPOs), networks of doctors and hospitals that adhere to given guidelines and fees in return for receiving a certain number of patients; and point of service (POS) plans, which are similar to PPOs but allow patients to go outside the network for treatment, usually at a higher cost. Some traditional health-insurance plans may also be managed care systems that require that more expensive procedures be reviewed and approved by a plan official before they are performed.
