DiFrancesco Signs HMO Right-to-Sue Legislation

DiFrancesco Signs HMO Right-to-Sue Legislation

Acting Governor, Donald DiFranceso, signed legislation on July 30, 2001 to allow persons to sue the carrier of their health and dental benefits plan for loss that occurs due to the carrier's negligence in denying or delaying approval of medically necessary covered services.

It is important to note, however, that Medicaid beneficiaries who receive their services through either "traditional" Medicaid or an HMO have the right to a Medicaid Fair Hearing before an Administrative Law Judge to present such disputes. Medicaid beneficiaries do not have to initiate or exhaust the HMO's grievance and appeals procedures or the Independent Health Care Appeals Program to be granted a Fair Hearing.