Another view of Medicare HMOs: not always what the doctor ordered. Interview by Meg Matheny.
Sally Hart Wilson is one of several lawyers who, on behalf of the Center for Medicare Advocacy, have filed a class-action suit seeking better protections for Medicare beneficiaries in HMOs. The experience of the lead plaintiff (one of 15) in Grijalva v. Shalala illustrates the down side of Medicare HMOs, says Ms. Wilson. Grigoria Grijalva, 71, an enrollee with diabetes, hypertension, congestive heart failure, anemia, and a uremic bladder, complained to her physician about pain in her foot. But the physician's treatment was inadequate, the complaint alleges, and as a result her right leg was amputated. In subsequent years, the lawsuit says, the HMO denied necessary skilled nursing home days and skilled home health services and never sent a notice of denial or a description of her appeal rights, as Medicare requires.
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Southern Arizona Legal Aid, Tucson, USA.
D000368:Aged; D001130:Arizona; D004608:Eligibility Determination; D005260:Female; D006279:Health Maintenance Organizations / Q000331:legislation & jurisprudence* / Q000592:standards; D006801:Humans; D016365:Liability, Legal; D006278:Medicare / Q000458:organization & administration / Q000592:standards*; D010344:Patient Advocacy / Q000331:legislation & jurisprudence*; D011787:Quality of Health Care / Q000331:legislation & jurisprudence*; D014481:United States