HMO

7 Pages 1659 Words

“In the United States of America…there are basically two groups of people who can’t be sued: foreign diplomats and HMOs” (Reid, 242). The ability for patients to sue their HMOs is not a guaranteed right. In most cases it’s not a right at all, at least not yet. Several cases have been won and Congress is trying to pass legislation to pave the way for this to change. Patients rely on HMOs to provide quality health care that covers their needs. Unfortunately this has not always been the case. HMOs can be negligent and can be guilty of malpractice; therefore, patients must be allowed to sue their HMOs for these wrongs.
HMOs, or Health Maintenance Organizations, were created to help curb rising health costs and provide managed care instead of pay-as-you-go doctors. The problem with these for-profit organizations is that they provide health care for large numbers of patients, and thus must deny certain types of care in order to keep costs low. Keeping costs low and trying to provide care that reflects what the majority of people need means that specialized care is left out. Yet even if an HMO refuses to provide care, it cannot be sued.
Denying care to patients, or having incompetent physicians are both forms of negligence. Judge Learned Hand is quoted in the article “Lawsuits Could Force HMOs to Improve Cost-Benefit Balance” stating, “ negligence occurs whenever it would cost less to prevent a mishap than pay for the damages predicted to result from it”’ (D11). This is definitely something that a company or individual can be sued for, but HMOs are covered by the Employee Retirement Income Security Act (ERISA) of 1974. ERISA restricts
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states from writing laws relating to “employer benefit plans,” such as HMOs. It was set up to “ensure uniform national requirements for multi-state employer plans,” and to protect “self-insured health plans from potentially costly state regulation” (...