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Home » Consumer Information » Medical Malpractice

HMO Malpractice

For many US citizens, health maintenance organizations are a cheap way to get the healthcare they are looking for. A health maintenance organization, or HMO, gives Americans an opportunity to pay reasonably priced monthly premiums, inexpensive copayments, and the liberty to choose from a broad selection of doctors. It sounds so convenient and easy on the pocketbook, but the trouble with HMOs is that they often refuse to foot the bill for important tests, do not reimburse policyholders for treatment included in the plan, and sometimes deny coverage of certain procedures altogether. This refusal to provide coverage is referred to as HMO malpractice.

HMO malpractice takes place during every step of the claims process. HMOs will:

  • Turn down perfectly eligible members.
  • Make abrupt, unreasonable choices to deny coverage after hearing policyholder dilemmas. This clearly makes the policyholder vulnerable.
  • Refuse to pay for various treatments due to the fact that they are too costly.

Besides the HMOs, doctors can also be blamed for their involvement in HMO malpractice. For instance, a physician may suggest that a patient undergo examinations that they are aware they will be compensated for. Since doctors know that HMOs restrict the total amount of hospital admissions, specialist recommendations, and exam requests that they are allowed to make, immoral doctors will reject the chance to administer various tests and treatment.

Lately, the legal system finally seems to be making an example of companies guilty of HMO malpractice. Actually, the number of claims against HMOs has been steadily rising over the past ten to 20 years, and people are winning large sums of money for the disservice. For example, a record $16 million was paid out to a patient by Prudential in 1992. Also that same year, a neurosurgeon was forced to cough up $600,000 to someone because they never identified a disorder that left the patient paralyzed from the neck down.

If you think you or someone dear to you has been victimized by an HMO, contact a Florida medical malpractice attorney as soon as possible. One can help guarantee a successful outcome by informing you of the statute of limitations and protecting your rights, one of which will be to receive compensation for your losses.