Right to Sue a Managed Care Plan passes House vote.

  1. Funny article on the passing of a managed care bill in the House in today's Washington Post. "Get Me a Cliche, Stat!"

    WashingtonPost.com
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  2. 7 Comments

  3. by   suellen e.
    I don't think that the passage of the managed care bill by the house is good news, do you? Legal costs of lawsuits will drive up the already exorbitant cost of healthcare to the point where few of us may be able to afford decent, good quality care - period. This would be shocking and frightening. Could you imagine paying $10,000.00 per year for health care insurance? (I currently pay $3600.00 for a family of three). Increasing one's ability to sue one's HMO would not be healthy for the economy nor would it improve the current strained relationships between the insurance companies, physicians, and patients. Sueing is definitely not the solution. It will not effectively solve the problems we are having with health care. Taking a look to see where we can cut costs would make a difference, and then making a commitment to continue to look at where cuts can be made. Review committees to constantly look at this. What do you think?
  4. by   Sharon
    I think the unspoken point of the article is to watch the quality of your e-mails because you never know who might print them. This has come back to haunt Gates and Naughton as well as the lobbyists in the article.
  5. by   HoJo
    What is wrong with being able to sue a HMO? If the HMO denies much needed care to clients jeopardizing their health, then they would deserve to get sued. Granted people are sue happy these days, but a bill such as this would make HMO's more accountable and responsible for their actions that can have detrimental effects on clients.

    If one of my family members died because the HMO is concerned about their profit loss and incresing the green lining in their pockets, then you can bet that I would sue the HMO for corporate negligence. Maybe more HMO's would think twice before the denying of much needed care.

    I think to fully understand the problem you have to first put yourself in the client's shoes.

    ------------------
    Class of 1999!!!
  6. by   Toto
    I never gave much thought about managed care
    until it struck home. You know treatment is available, but kept just out of reach.
  7. by   mn nurse
    HMOs do not direct medical care; they direct reimbursement. The patient is always able to pursue any treatment avenue he or she chooses, but if it isn't covered by the contract with the HMO, another source of funding must be found. Yes, this gives an advantage to the people with the most financial resources...welcome to capitalist America.

    What's interesting is that nobody talks about sueing HCFA, and Medicare is not only extremely limiting in what is covered, but a patient can't even call and plead the case to a live person or ask that the decision be reviewed by a physician. What's covered is what's covered. Period. The end. Why should other payers be expected to to make exceptions? Because the top execs make a lot of money? The top government execs do alright, too!

    If I sign up for a basic indemnity plan, 80/20 coverage on hospitalizations, no preventative coverage, and choose not to go in for an annual pelvic exam because it's not covered, can I sue when I find out I have advanced cervical cancer? No. Why should I be able to sue an HMO if I choose not to get care based on a lack of coverage?

    By the way, HMOs cover more preventative care and offer more programs to help people maintain or improve their health than any other type of payer, at least in this part of the country...
  8. by   Bengal
    I am an RN BSN and happily employed by an insurance company. I agree with mn. We do not direct care but do direct reimbursement.
    Have you heard that old saying "you get what you pay for"? The same goes for Health Care Coverage. The higher the premium the better the coverage. When buying a car if you buy a Geo you get a Goe-not a Cadillac-does that mean because I want a Cadillac I can sue the Geo company because when I made my first payment it didn't turn into a Cadillac? I doubt it.
    It does however enable our society to remain irresponsible for themselves. Most Americans who are insured have no idea what their Health Coverage Contract does reimburse. It is easier to point fingers and sue than to be a responsible Health Care Consumer.
    I wonder does the House realize appropriate settings means chest pain symptoms are best dealt with at the ER? That the procedure of freezing warts most appropriate setting is not the er?
    I wonder does the house realize doctors sometimes don't want to be the bad guy and tell the patient no so they order a service anyway knowing the insurance company will the one to say no?
    I wonder does the House realize Medicare's philosophy is basically the same as this right? The concept is good but there are a lot of greedy people out there. Ask the home health agencies that got audited and were deemed by Medicare to "payback".
    I wonder does the House care if Medicare monies will be gone by the time I need it? I doubt it-The House is fully insured.
    I don't know the answers to the problem-but I do feel the Right to Sue will only increase costs, allow providers more creative billing strategies, increase ignorant Health Care Consumers, increase the now mentallity and irresponsibilty of our society-and that is the part that bothers me.
    Society will remain ignorant (blissfully unaware) as long as they don't have to take responsibilty.
  9. by   jbresolin
    22 states are considering legislation regarding external review by panels of experts. 18 states have it. 50% of decisions reviewed are overturned. $500 cost compared to malpractice suit. Process may be laborious because HMO may have several layers of internal review. ( Sandra Boodman,Wash. Post)Perhaps this is a reasonable alternative to sueing. There should be some mechanism to address poor quality. The context of care determines decision making, pressures and incentives from management are an important part of the equation.

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