Health maintenance organizations work closely with patients to connect them with providers who can provide the care they need. In exchange the HMO receives a fixed payment agreed with the insurance company. Providers must apply to be in the network. In order for a provider to become an in-network provider, they must have specific credentials to demonstrate that the quality of care will be met. This ensures that providers meet service requirements and are less likely to have malpractice issues, however, should they encounter any issues, they must have malpractice insurance to cover them. The HMO reviews potential providers before approving them to be in-network because of the responsibilities that may fall on the HMO for approving that provider. (DiCicco, 1998) The HMO helps reduce unnecessary specialty and emergency visits by requiring primary care physician referrals. This reduces costs and delegates patients to appropriate providers; however, it can be difficult for patients who need care more quickly than they can get due to the referral process. Assigning, receiving and processing referrals can be a time-consuming process for larger practices that can cause strain on staff members and patients waiting for referrals to seek further care. (Steele, 2013). Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an Original Essay An example of this process causing medical crises for patients and malpractice lawsuits against the provider is the 1988 case of Boyd v. Albert Einstein Medical Center. A patient needed a biopsy and after receiving the test she was injured further and continued to get worse. Since she had an HMO, she went back to the primary provider she had originally received a referral from, but it wasn't enough. This patient needed emergency care to which the provider did not refer her. Instead he received tests on which it would take days to receive results. If she had been transferred to the emergency room, she might have had test results sooner and perhaps a different health outcome. The patient lost her life due to the negligence of the doctor who carried out the tests knowing that the results would not arrive in time. (Hall, & Orentlicher, 2013, p. 129). HMOs need to watch their referral and denial actions carefully, or risk a case of HMO negligence. Reasons why these cases may be raised are: Denying needed diagnostics in life-threatening cases Reusing referral requests that are necessary (including to out-of-network providers, when necessary) Refusing to transfer a patient to another facility when necessary (if the current facility cannot provide necessary diagnoses or treatments) Refusal to seek a second opinion from outside providers when an in-network provider is not sufficient There is the possibility of legal action against the HMO in these situations it may be negligence on the part of the medical, wrongful death due to denial of specific needed services resulting in the loss of a patient's life, as well as bad faith lawsuits for denying claims that should have been paid without issue. An insurance company cannot deny routine covered services without reason. For each rejected request, a legitimate reason must be provided. Services that are considered medically unnecessary may not be covered or require authorization. An example is acupuncture, which is considered alternative medicine and is unproven, 2011).