The injection of HMOs in the healthcare industry and between the doctor and the patient is an unfortunate, recent trend in medicine. The problem is more than just rationing healthcare – it destroys healthcare in several ways. If you have reason to believe that you may have an HMO negligence claim, it’s important to contact an experienced personal injury attorney to fight your case. The Fort Lauderdale HMO negligence attorneys at Kelley | Uustal would be happy to meet with you for free to discuss the details of your case.
Why Capitation Can Be Dangerous for Patients
Capitation is a system that HMOs use to compensate doctors. A capitated physician is usually paid a set amount of money per patient on his or her “list” each month – commonly an amount between $5 and $10. As a result, the only way a doctor can make more money is to have more patients on his or her list. But the more patients on the list, the less time spent with each and the greater the chance that medical malpractice will occur.
Dangers of capitation:
- Capitation often includes provisions that financially discourage the doctor from ordering testing. Their contracts frequently contain a list of testing procedures that must be paid out of the doctor’s own pocket. Sometimes the ordering of tests will cost the doctor more than he or she makes for the year of having the patient on their list! This creates a serious disincentive to perform necessary testing and follow-ups.
- Doctors want to maintain their “preferred provider status.” HMOs rate their doctors based on their utilization – a fancy way of saying they monitor how much a doctor costs them in test requests and hospital stays. Doctors fear that if they order what the HMO might consider to be too much testing they might lose their preferred provider status, and a large portion of their patients, which can be a significant deterrent.
- Many times hospital stays and expensive testing or treatment must be pre-approved by the HMO – and sometimes they say no! Unfortunately, they sometimes say no to medical testing and treatment that could have saved a person’s life.
Misuse of ERISA
ERISA is a federal law that was originally designed to protect people from big insurance companies. However, a very small section of this act provides that an individual has the right to file a grievance against their HMO. Another provision of the law says that ERISA preempts state law. Some courts have put these two together and concluded that ERISA’s right to file a grievance against an HMO preempts state medical malpractice law in Florida.
Contact Our Fort Lauderdale HMO Negligence Attorney
Kelley | Uustal was involved in an HMO negligence case involving the death of a 6-year-old girl. She was taken to her pediatrician for treatment of persistent vomiting. Her doctor correctly recognized that this could be a sign of a brain tumor. As a result, he ordered a CT scan. The request was rejected by the HMO for the reason that it was “not medically indicated.”
Months later, the little girl started screaming and holding her head. The tumor had expanded to the point that it eventually resulted in her death. It turned out to be a fast-growing benign tumor that would have been treatable back when the HMO rejected the doctor’s request for a CT scan. With our help, the family was able to recover $7 million in damages. HMOs do not have absolute immunity in Florida.
If you think you have suffered an injury due to the negligence of a Health Maintenance Organization, contact our Fort Lauderdale personal injury lawyers for a free case evaluation. Our team has the experience necessary to handle cases involving HMO negligence. You will pay no fees until we are able to recover compensation for your injuries.