Should you be able to?  In the article Suicide by Managed Care, Rand Partridge, Ph.D. illustrates some of the reasons that many people believe that you should.   If an insurance company refuses to pay for a life-saving treatment, should they have some responsibility for this decision?

Lawsuits against managed care companies are beginning to happen now.  The Illinois Supreme Court recently ruled that individuals can sue their health maintenance organizations (HMOs) for malpractice, according to court documents. This follows a landmark case where an Ohio jury awarded $51.5 million to a woman whose HMO would not pay for cancer chemotherapy. The woman died of the cancer. 

Many of the most recent lawsuits are not for the denial of needed care - they are for fraud.  The suits assert that many managed care companies misrepresent themselves to consumers.  The companies are said to promise consumers a range of benefits, then to deny these same benefits to the consumers when they need them.  

The American Psychological Association sued MCC Behavioral Care for dropping providers from its panels.  In a more recent action, the Virginia Academy of Clinical Psychologists is suing Blue Cross/Blue Shield of the National Capitol Area for fraud.  The company is said to have promised between 20 and 52 visits per year to patients, then to have denied these visits to patients when they needed them.  

A new lawsuit appears to be around the corner.  This one has already affected the stock prices of some HMOs, according to the Los Angeles Daily News.  The article quotes Joseph Sellers, an attorney with Cohen, Milstein, Hausfeld & Toll in Washington, said he was "in the process of developing a class-action lawsuit against one of the nation's largest HMOs alleging fraud." The company has not been named, but Sellers said the lawsuit would claim that the HMO "is willfully misrepresenting the benefits it provides patients in an effort to maximize profits." After this story appeared Reuters reported that Aetna and Humana were both facing class action lawsuits.

Lawsuits should always be a last resort, in my opinion.  If managed care companies know that they are subject to lawsuits, however, they may think twice before denying needed care simply to save money. 

• Suicide by Managed Care - an in-depth look at some of these issues

• A Detailed Comparison of the House and Senate Versions - from US Government Guide Robert Longley

• Psychologists File Suit Against CA Managed Care Entities - from APA
• Further information on the VACP - Blue Cross lawsuit - from APA
• Patient Bill of Rights Victory - from the Back and Neck Guide
• What do you think?