A Collection of Problems with the US Health Care System

Attorney. California. Statement 10060.

Categories: Legal Professional Statements
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HMO plans have millions of members who are promised in their policy that they will only be liable for the co-payment. However, their in-network hospitals impose a form “Conditions of Service” that makes the member personally liable for all charges. The HMOs have had about 400 of their medical groups, which are supposed to pay the ER doctors, go bankrupt over the last 7 years. When the ER doctors don’t get paid, they try to collect from the member who supposedly bought a pre-paid plan. This is because the ER doctors can’t make the HMOs pay them directly based on a line of cases beginning in 2001. This is like a “shell game” where the member becomes trapped under the last shell turned over by the ER doctors looking for payment. The policies should include a statement that if you pick an HMO, you may get calls at home at night and your credit might be threatened. This shedding of downstream risk back onto members by the HMOs should be considered by consumers in making their decisions about plans. “In house” type HMOs that actually provide the medical care, instead of contracting with others, do not seem to be able to play these games so much because it’s ER doctors are “in house”, generally. If you check the Department of Managed Care’s website, you can see one HMO was fined in January 2005 for $250,000 for not paying hospital based care providers. They were fined for similar problems back in 2000. But this is just a cost of doing business because it works out to only 12 cents per member. Consumer beware.