HMO Malpractice
For many Americans, health maintenance organizations (HMOs) are a blessing in disguise. The affordable monthly premiums, low co-pays, and freedom to choose a doctor makes them appear relatively light on the checkbook. But when HMOs refuse to pay for necessary tests, fail to reimburse patients for treatment that should be covered, and flat out deny coverage to an eligible policyholder, this blessing can turn into an extraordinarily expensive nightmare. Such denial of coverage is called HMO malpractice.
HMO malpractice occurs in every stage of the claims process. For one, HMOs all-too-often fail to recognize eligible policyholders. Second, HMOs make hasty, unfair decisions to deny coverage when reviewing policyholder situations and requests, thus putting patients at risk. Third, they unabashedly refuse to administer treatments simply because they think they are too expensive.
However, it is not just the HMOS who are to blame – physicians, too, play a role in HMO malpractice. For example, doctors sometimes only recommend tests and procedures for which they know they will be reimbursed. Also, because they know HMOs set limits on the number of hospital admissions, specialist referrals, and test requests doctors can make, unethical doctors area frequently inclined to withhold tests and treatments from patients.
The law, however, is finally cracking down on those who commit HMO malpractice. In fact, in the past decade, there has been an increasingly number of lawsuits brought against HMOs and won, including a record $16 million suit brought against Prudential in 1992 and a $600,000 suit brought in 1992 against a neurosurgeon whose failure to properly diagnose a medical condition left the plaintiff a quadriplegic.
If you believe you have been a victim of HMO, malpractice, you should discuss your case with a personal injury lawyer right away. He or she can help you ensure a successful case by explaining the statute of limitations and seeing to it that your rights are protected. He or she can also help you obtain the compensation to which you are rightfully entitled. Category Archive | Find a Lawyer
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