HMO DENIAL CLAIMS

Health care in America is changing rapidly. Twenty-five years ago, most people in the United States had indemnity insurance coverage. A person with indemnity insurance could go to any doctor, hospital, or other provider (which would bill for each service given), and the insurance and the patient would each pay part of the bill.

1. But today, more than half of all Americans who have health insurance are enrolled in some kind of managed care plan, an organized way of both providing services and paying for them. Different types of managed care plans work differently and include preferred provider organizations (PPOs), health maintenance organizations (HMOs), and point-of-service (POS) plans. HMOs are the most common type of managed Health care. Currently, there is much concern regarding the injuries and deaths of HMO members caused by delayed care or denials. Also of concern is their right to sue for damages.
It has been very difficult to hold HMO's accountable for injury and/or death caused by delayed or denied care. Currently, the U.S. Congress is in the final stages of attempting to create legislation that will allow a victim of HMO malpractice to sue that HMO.