HMO Law
HMO law refers to the laws regulating Health Maintenance Organizations (HMOs) and their plan members. An HMO is a group that contracts with physicians, hospitals, clinics, and employers to provide healthcare to a group of individuals. In this type of insurance, the individual's employer pays for most of the premiums.
Types of HMO Law Cases
There are several types of cases that can be brought against HMOs, including:
- Wrongful death - HMOs can be sued when a person dies as a result of the HMO denying coverage for necessary medical procedures.
- Bad faith - HMOs can be held liable for denial of valid claims
- Malpractice - an HMO may be held liable for medical malpractice by one of its physicians
HMO Negligence
HMO negligence refers to any action by an HMO that results in the injury or fatality of one of its patients. Examples of HMO negligence include denying coverage of necessary medical procedures, denying coverage for necessary medication, and having a doctor in its network that is known to be guilty of medical malpractice.
ERISA
The Employer Retirement Income Security Act (ERISA) was passed in order to require employers to pay pensions to their retiring employees; it covers all employee benefit plans, including health care. Lawsuits brought under ERISA can only be filed in federal court, and since medical malpractice is a state issue, employees who sue HMOs for malpractice will typically have their claim thrown out. Patients with individual HMO plans can sue within their respective state.
If you are interested in learning more about HMO negligence and HMO law, you may want to contact an HMO lawyer for more information.
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