Word: hmos
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...separate decision last Wednesday, it topped those figures off with a breathtaking $116 million in punitive damages, concluding that Aetna had acted with fraud and malice. The jury "sent a message," says Jamie Court, director of Consumers for Quality Care, a California-based watchdog group. Not just to the HMOs, he adds, but also to Congress, which should "pay attention to denial of rights that kills patients...
Originally designed to shield employee benefit plans from frivolous but potentially crippling lawsuits, ERISA evolved over time to protect HMOs from liability suits by anyone--except Medicare and Medicaid recipients, church officials and government employees like Goodrich. Others can go to court, but at most they are entitled to recover the cost of the care that their HMO refused to reimburse. Not much consolation...
...Bill of Rights, a crucial element of which would be the right of any consumer to hold an HMO legally accountable for its medical blunders. Such unlikely allies as consumer-advocate groups and the American Medical Association support this reform. They argue that in attempting to practice cost control, HMOs end up practicing medicine. Even judges have voiced frustration. Ruling in favor of an HMO in an Oklahoma case in which the insurer delayed a bone-marrow transplant for a woman, who later died of leukemia, a three-judge panel in the 10th U.S. Circuit Court of Appeals wrote, "Although...
Some good and bad news on managed care: Aetna U.S. Healthcare said last week that it would allow its customers to appeal coverage denials to an external review board. Other HMOs, like United Healthcare, are expected to follow suit. But many HMOs are raising average co-payments for prescriptions $5 to $15. Tip: stick with generic drugs...
...seen as supportive of Bill Clinton. The firing is the latest in a string of controversies. In 1997 the AMA agreed to endorse Sunbeam medical equipment in what many saw as a conflict of interest. Last year it alienated conservatives by supporting a health-care proposal to make HMOs liable for malpractice. Lundberg's lawyer disparaged the group for interfering in the "inviolable ground of editorial independence" and said his client...