Scull v. Groover, Christie, & Merritt, P.C.

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Petitioner had health care insurance as a member of the United Healthcare Select HMO (the HMO) when he visited a healthcare provider (GCM) for an x-ray of his knee. After Petitioner paid a bill he received from GCM for the x-ray exam he filed a complaint alleging that the bills GCM sent Petitioner were an illegal attempt to "balance bill" an HMO member in violation of State law and that the bills constituted an unfair and deceptive practice in violation of the Consumer Protection Act (the Act). The circuit court dismissed the complaint. The court of special appeals affirmed. The Court of Appeals affirmed in part and reversed in part, holding (1) the state HMO law prohibiting balance billing by health care providers as part of the legal foundation for the establishment of HMOs does not include a right of action by an HMO member against a healthcare provider for violation of that prohibition; but (2) an HMO member may bring an action under the Act against a healthcare provider who improperly bills the member in violation of the state HMO law in a way that also violates the prohibition against unfair or deceptive trade practices in the Act. View "Scull v. Groover, Christie, & Merritt, P.C." on Justia Law