Courts as gatekeepers in managed care settings


John Petrila

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Recently, a court ordered that a woman convicted for driving while intoxicated receive alcohol treatment.1 The managed care company responsible for administering the program that was to treat her denied payment. A representative of the company, commenting on its decision, was quoted as saying that “treatment is not medically necessary [simply] because it is courtordered.” 2 This dispute illustrates a type of conflict thatmay become increasingly common as government contracts with private managed care companies to administer publicly financed human services programs in which judges function as primary gatekeepers. This conflict and suggestions for resolving it are the subject of this Commentary.