HMOs may yet become an important means for effecting health care savings. But to attain that goal, they must confront the challenges facing them--such as regulatory restrictions and intense competition.
HMOs may yet become an important means for effecting health care savings. But to attain that goal, they must confront the challenges facing them--such as regulatory restrictions and intense competition.
A residential facility that treated preadolescent children suffering from functional nervous disorders was considered to be a "hospital" for purposes of coverage under a group medical insurance policy, despite the fact that it lacked an on-premises surgical facility and did not provide 24-hour nursing services by registered nurses. The insurance company had waived the surgical facility requirement. Additionally, since the policy in question did not contain a definition of "nursing services," there was no requirement that these services be provided 24 hours a day by registered nurses. Thus the insureds were entitled to coverage of the treatment for their son in the residential facility. But a bad faith claim was denied because the insurer's interpretation of its policy was not found to be unreasonable.
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