Best & Anderson, P.A. Personal Injury Blog

Millions of Americans are living without any type of medical insurance. Millions more may have a kind of insurance called a health maintenance organization (HMO). These are cheaper for employers than traditional insurance, but there are problems with them since the employee eventually pays some kind of price for having them.

While these are supposed to be better than having absolutely no insurance at all, they are often substandard plans that lead to substandard care from doctors and hospitals more concerned about money than treatment. This care can lead to other instances of failure or negligence by HMOs and their doctors, including:

• Denied coverage (bad faith)
• Failure to treat in emergency situations
• Failure to run diagnostic tests
• Failure to transfer patients to another medical provider
• Misdiagnoses leading to life-altering injury or death

One of the questions people caught up in these situations ask, is how can physicians treat people in need like this? The answer is that the physician or health care provider and the HMO have an agreement, or contract. In some instances, these health care providers are directly employed by the HMO, or are independent contractors. The HMO pays the physician one fee for all the services, and because of this, the physician will try to keep costs low. So, if the patient has been told they need to take one kind of medication, an HMO-paid physician might switch the medication to a generic one that either doesn’t work as well, or has unanticipated side-effects.

Another act HMOs have been known for is paying bonuses to health care providers who keep referrals to specialists to a minimum. Others state they need to review the primary care physicians recommendations before approving treatment. These lead to delays that can wind up killing people who could have been saved.

If you or a loved one has been injured in some way by the negligence of an HMO, please contact us to see if you have a claim.