Wednesday, March 21, 2007

Some "horror" stories related to...Greed & HMO's

A 32 year old woman, married with 3 children came down with breast cancer and her HMO denied her care that cost $150,000.00 which the HMO was obligated to pay for. This resulted in a delay of 6 months while her family and friends raised the money so she could go to another medical center to have the treatment. She later died and it was found out that the medical director of the HMO, who had no expertise in breast disease or cancer and was not a practicing physician, was being given bonus pay at the end of the year based on how much the HMO was profiting. It also came out that employees of the same HMO who had the same breast cancer received the treatment and payment from the HMO.

A young man with serious psychiatric problems was admitted to a psychiatric hospital. Later the insurance company put pressure on his psychiatrist to discharge this unstable gentleman early, who later committed suicide. The physician reviewer for the insurance company who put the pressure on the psychiatrist was a physician student in neurology.

A young man who had bills of over $25,000.00 for medical care at a medical institution was told his insurance company would only pay $6,500.00, because the insurance company on its own felt the rest of the care was not medically appropriate. The family sued and the court found that the insurance company was making up its own standard of medical care and not relying on objective nationally acceptable medical standards in making its decisions.
A hospital was fined millions of dollars when a family sued because their family member was discharged too early from the hospital. The court found out that when the hospital discovered that the person's medical insurance was running out it pressured the patient's physician to discharge the patient early.

A patient who had HMO medical plan did not receive the proper cancer treatment from the patient's cancer doctor, because the University Medical Center pressured the doctor not to do so. The medical center was allegedly getting pressure from the patient's big HMO that it did not want to pay for the treatment and threatened the hospital that if it allowed the treatment, the company would transfer all patients under their plan to another hospital.

A young man died of an acute heart attack after a nurse on an HMO telephone "help line" refused his wife's request to take him to the nearest emergency room.


No comments: