Congress Debates Current Law That Limits Patient Lawsuits Against HMOs

By Brian Vargo

Published on July 22, 2005

Individuals who have been denied necessary treatment by their HMO are within their legal rights to sue for the amount of treatment that was denied. However, patients are unable to claim punitive damages if an illness or death resulted from the lack of treatment.

Democrats have proposed to allow patients to sue for punitive damages. However, Republicans are satisfied with the current law, but would consider a panel to review claims against HMOs.

The GOP reports that changing the law would create more federal bureaucracy, causing an increase in the cost of healthcare.

However, without changes to the law, HMOs can deny requests for treatments with the worst repercussion being that they may be sued and have to pay the cost of treatment later.

A possible alternative is a compromise, leaving HMOs responsible for both the cost of treatment and punitive damages if a physician's recommended treatment is denied.

In the meantime, patients who have been denied treatment or have a problem with their HMO, may want to hire a lawyer.

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