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Los Angeles HMO Dispute Lawyer

Understanding Health Management Organizations

One of the most common types of managed care insurance systems is the Health Maintenance Organization (HMO). This type of service provides the consumer with general health and wellness benefits including annual physical exams and gynecological appointments for women. Any other medical need outside of this general covering must first go through your general practitioner. The Primary Care Provider (PCP) is the physician who can refer you to specialists outside of basic medical issues such as x-rays or lab tests.

If you fail to receive a referral, you must pay the specific doctor the amount for the service rather than the discounted copay. There is a yearly premium that is paid for by the consumer as well as copayments for each and every visit to doctors under the HMO umbrella. People find this type of health care insurance to be profitable because costs are more dependent upon your need for medical help thereby allowing it to be the most affordable plan.

What if my claim is denied?

According to California Health and Safety Code §1340, it is illegal for an HMO to wrongfully deny any legitimate claims or wait unnecessarily long to approve a referral for medical care. Often you can personally dispute the case with the HMO directly, but this can prove futile on occasions where they are purposefully neglecting your medical needs. It may be difficult to determine what chance you have of receiving the necessary coverage unless you speak to a lawyer. At our firm, we have handled a large number of cases and lawsuits dealing with issues such as this. Before you give up, allow one of our qualified Los Angeles insurance attorneys to talk with you about the options you have.

Contact Our California Insurance Attorneys

Having been in the legal field since 1979, we have a qualified legal team that is ready to help you in disputing your denials. They can figure out if your case is against the HMO or if there needs to be a lawsuit filed against the physician. There are a myriad of settlements that can occur as a result of negligence on behalf of the HMO, but sometimes they have nothing to do with the way in which a doctor has provided care. When you have legal representation by your side, they can sift through the laws, investigate the issue at hand and determine what would be most profitable for you. Contact our firm today to learn what we can do for you!

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