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Re: Managed care and lawsuits (long) From: art fougner, md (evsono@pipeline.com) Thu Oct 14 07:53:29 1999 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: Managed care and lawsuits (long)" Previous message: Ashraf Abuali: "ART COURSES& DEGREES" In reply to: Garry E. Siegel, M.D.: "Gyn: Continuous Combined HRT" Next in thread: Ronald E. Ainsworth: "Re: Managed care and lawsuits (long)" Reply: Ronald E. Ainsworth: "Re: Managed care and lawsuits (long)" when these situations arise, involve the medical director. usually, this solves the problem. if not, forward the medical director's name to your malpractice carrier. since he is licensed to practice medicine, he CAN be held accountable for his MEDICAL decisions. have never had to test this, but in theory, it should work. Art At Wed, 13 Oct 1999, Ealgail@aol.com wrote: > >In a message dated 10/13/99 9:00:40 PM Eastern Daylight Time, >RModugno@aol.com writes: > ><< Why in the world should a for-profit MCO be shielded from > legal recourse either by me or the patient for such > outrageous and clearly indefensible behavior? >> >In this case, they are probably not immune. Usually we just go after them >for the wrong thing. Of course, the behavior is indefensible and outrageous >in a medical sense. They really can't make up their own criteria and then >keep them secret. However, the legal basis is "breach of contract". They >have a contract with the patient to provide care. Care for diabetes is a >covered service. They denied the patient that service; thus, it is breach of >contract and the patient should file suit. Then, they must produce their >criteria in defense. It is put up against the ADA criteria and let a jury >decide. You know how it will come out. Juries hate insurance companies; >like we all do. >HMO's and MCO don't care if we get mad. They don't even care if the patients >get mad. Actually, they don't even care if we leave them or the patients >leave them. They do care about being accused of breach of contract; contract >law is pretty clear cut. They don't like having to defend anything in front >of a jury. You can't sue them about patient care; you can always sue them >about breach of contract; that is not protected in any way. > >Linda >Linda Morrison-Boczar, M.D. FACOG >Private Practice -- "Of course, that's just my opinion. I could be wrong." -----Dennis Miller art fougner, md SonoScan/Genetic Sciences forest hills, ny evsono@pipeline.com Next message: art fougner, md: "Re: Managed care and lawsuits (long)" Previous message: Ashraf Abuali: "ART COURSES& DEGREES" In reply to: Garry E. Siegel, M.D.: "Gyn: Continuous Combined HRT" Next in thread: Ronald E. Ainsworth: "Re: Managed care and lawsuits (long)" Reply: Ronald E. Ainsworth: "Re: Managed care and lawsuits (long)"

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