HMOs Hold Department of Managed Health Care Responsible for Protecting Patients Rights

By Cecilia Green

Published on August 10, 2005

In the state of California there are 23 million people enrolled in HMO plans. These patients expect their HMO to cover the cost of necessary medical treatments. Yet, what happens when the HMO refuses to pay all or part of the cost they agreed to be responsible for?

While it is illegal for the HMO to refuse to pay their share of a patient's medical bills, it is difficult for patients to protect their rights when the insurance company fails them. Oftentimes, taking their case to court is the only way patients are able to get the HMO to pay their rightful share.

While HMOs hold the Department of Managed Health Care is responsible for enforcing lawful practices, particularly those related to the Knox-Keene Act and state consumer protection laws, their lack of enforcement leaves patients feeling trapped.

With insurance companies refusing to pay for their medical treatment, some doctors illegally bill the patient for the remaining balance. These unpaid medical expenses can leave the patient with a bankruptcy or poor credit.

Taking legal action against their HMO is often the only way patients are able to recover money they are rightfully owed from their insurance company.

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