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HMO refusal of ER coverage

By Linda Cahn

As an attorney, I have been approached by several individuals who have been refused coverage by HMOs for emergency room treatment. Preliminary research that I have conducted indicates that this is a widespread problem that is causing enormous distortion in the delivery of medical treatment, as well as leaving numerous hospitals and individuals with uncovered emergency room bills.

I would be interested in learning of others' perceptions on this problem. How widespread is it? Which HMOs are particularly notorious for refusing payments, without justification for doing so? etc.

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