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HMO Liability
What if you have been denied medical care pursuant to you HMO, PPO or Healthpan? You may have recourse in state or federal court.
Claims against an HMO, PPO or other employee benefit healthcare plan may be protected by ERISA. ERISA preempts state law in an effort to protect employers from state tort and contract actions. If benefits are denied, then a plan participant may be entitled to bring an action in federal court. Damages are limited to the recovery of the costs associated with the health services previously denied. If the company acted in bad faith, a plan participant may be entitled to attorney fees, costs of the action, but non-economic damages are prohibited. Presently, several bills are pending before the United States Congress, typically known as a "Patients Bill of Rights". It is believed that consumers will ultimately prevail in presenting claims against their managed healthcare plans. Of interest, the United States General Accounting Office and Congressional Budget Office reported that: Although HMO's appear to reduce the level of health care costs, there is no credible evidence that they also reduce the rate at which costs subsequently increase. The claim that the rate of growth is lower for HMO's than for Fee For Service plans is based on a comparison of growth in premiums over the past few years. That evidence, however, is too weak to support any conclusion about the relative growth of costs for different types of plans. Thus, if you have been denied services for reasonable and necessary healthcare by your plan, you may have a legitimate remedy.. |
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