Historic Court Decisions Rule Against HMOs on Medical Necessity and Quality of Care

OPEN MINDS, The Behavioral Health & Social Service Industry Analyst Industry News Two historic court decisions are sending shivers through the managed care world. On October 20, 1998 the Jefferson Circuit Court of Louisville, Kentucky ruled in favor of Mrs. Karen Johnson in her lawsuit against Humana Health Plan. Mrs. Johnson alleged that Humana denied "medically necessary" treatment as part of "a system of denial” designed to increase corporate profits. After Mrs. Johnson was diagnosed with cervical cancer in 1995, her physician determined that a hysterectomy was necessary to save her life. Humana, on the other hand, said that a . . .