Wrongful Denials of HMO Treatment in New York are Common and are Often Successfully Appealed

Many patients of health maintenance organizations (“HMO”) are unaware of their legal right to appeal a decision denying their requested treatment. The desired treatment is normally denied deemed as”medically unnecessary” or “experimental.” The law also only provides for a mere 45 day deadline in which one can file this appeal.

The ignorance of various patients of their ability to appeal is particularly problematic in light of the fact that, according to the New York State Insurance Department, approximately 42.6 and 49.4 percent of the cases that are appealed are in fact reversed.

Therefore, it is important that patients are made aware of their ability to appeal their denial of medical treatment and should in fact be encouraged to seek legal counsel to ensure that they are not unreasonably and wrongfully denied treatment. This is especially in light of the fact that the aforementioned wrongful denial of treatment has already led to a multitude of unnecessary deaths.

The New York External Review Board has been around for the past eight years pursuant to Public Health Law Section 4910-16, and within this time frame, in nearly half of the cases, outside reviewers have overruled HMO denials of treatment. These denials have grave potential consequences, including causing patients serious injury and death. For instance, sadly enough are denials are at times made by unqualified physicians, despite the fact that other doctors have warned that the cutoff of treatment could lead to death and/or dire injury.

It is important that patients who are denied treatment by HMOs not just blindly accept the denials but question it and appeal the decision. The statistics support this inasmuch as within the year of 2006 alone, there was a reversal rate as high as 48.6 percent and out of the 1600 denials that were reviewed, 778 of these denials were overturned.

If you or someone that you know has been denied medical treatment by an HMO, consider your legal alternatives and contact Levine & Slavit, Esqs. in Long Island or New York. For 50 years spanning 3 generations, the personal injury lawyers at Levine & Slavit have handled medical malpractice cases in New York City, the Bronx, Brooklyn, Queens and surrounding areas, obtaining results for satisfied clients.

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