By: Shernoff Bidart Echeverria LLP
Share This Post
TRADING MEDICARE FOR HMO
California Insurance Bad Faith Trial Lawyers for Plaintiffs
From our law offices in Beverly Hills and Claremont, California, we represent plaintiffs in wrongful death lawsuits throughout Northern and Southern California including Los Angeles, San Diego, Sacramento and Santa Ana, as well as Orange County, San Bernardino County, Riverside County, and Los Angeles County.
Beware of Trading Medicare for HMO Coverage
A 68-YEAR-OLD MAN assigned his Medicare benefits to an HMO in return for coverage to match or exceed his minimum Medicare benefits. Among the promised benefits were 100% payment of comprehensive inpatient and outpatient rehabilitation services.
Six months later, the man broke his hip in a fall. After surgery, he suffered serious complications, including two major heart attacks, pneumonia and a large blood clot in his leg. When he was finally moved out of the intensive care unit, he was still unable to walk or stand.
He required extensive rehabilitation, so he was transferred to a rehabilitation facility, where he began a physical therapy program.
The HMO questioned the man’s ability to participate in the program and mandated that he be admitted instead to a nursing home, which was less expensive and had no rehabilitation program.
The man’s physicians maintained that he needed physical therapy, after which he would be able to walk normally again. The HMO turned a deaf ear, refusing to pay for physical therapy on the grounds that it was medically unnecessary.
At this point, attorney Michael Bidart initiated legal action against the HMO. The unanimous support of all three of the man’s doctors—his personal physician, his hospital physician and his hospital psychiatrist – made Bidart’s case exceedingly strong.
Moreover, the physical therapy services the man’s doctors recommended were clearly within Medicare guidelines and had been overruled by HMO representatives only because they were getting paid to say no.
Three years after filing suit, the man received a multimillion-dollar settlement from the HMO.
Fortunately, while waiting for the lawsuit to be settled, he was able to continue physical therapy with the help of a charitable foundation, and he eventually made a full recovery.