OHA: Background

Background

An overview of Managed Care

Managed care is a health care system involving the active coordination of, and the arrangement for, the provision of health services and coverage of health benefits. Managed care usually involves three important components: oversight of the medical care given, contractual relationships and organization of the providers giving care, and the covered benefits.

Managed care has rapidly dominated the health care financing and delivery system in the United States. In Connecticut, most health insurance consumers are enrolled in managed care plans. During the past several years, the commercial or employed segment of the Connecticut population has been joined by some Medicare enrollees.

The Office of the Healthcare Advocate (OHA) was created in 1999 by the Connecticut State General Assembly by passage of Public Act 99-284 "An Act Concerning Managed Care Accountability".

OHA helps Connecticut consumers with healthcare coverage issues. The office was created to promote and protect the interests of covered persons under health plans in Connecticut. A major responsibility of the office involves educating consumers about their rights and how to advocate on their own behalf when they have a problem or concern about their healthcare plan. We can answer questions and assist consumers in understanding and exercising their rights of appeal of a denial of a benefit or service made by the healthcare plan.