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Controlling Costs and Changing Patient Care?: The Role of Utilization Management (1989)
Institute of Medicine (IOM)

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. "Appendix A - Legal Implications of Utilization Review." Controlling Costs and Changing Patient Care?: The Role of Utilization Management. Washington, DC: The National Academies Press, 1989.

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physician to add a new economic dimension to the physician's determination of medical necessity, which must be communicated to the patient.

92. In one case, the court apparently refused to relieve the patient of payment responsibility, even though the insurer denied coverage because the treatment was not medically necessary. Albert Einstein Medical Center v. Lipoff, No. 3872X (Ct. of Common Pleas, Phila., Apr. 23, 1973), described in Eisenberg and Rosoff, supra, note 1. In that case, the patient sought to hold her physician contractually liable for the hospital bill. The court denied her claim, reasoning that her claim sounded in tort and that she could recover only by proving that the doctor's treatment was medically unsound. That it was economically unsound was irrelevant to a tort claim.

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