All third party payers HMO/PPO managed care providers must be prohibited from denying care or payment for care rendered. Their existence in the health care arena was intended as a buffer for insurance companies to deny care or payment for care.
The purpose of managed care was to reduce cost to the insurance companies who employed them for the purpose of reducing the amount paid to below reasonable and customary rates set by the insurance industry, or to fabricate a plausible rationale for denying payment outright.
Their continued existence in the health care arena is giving license to defraud the buying public of services they've paid to have covered but will likely not receive due to an arbitrary denial or fraudulent claim review. This has caused health care costs to skyrocket.