Question

if a health care professional terminates treatment because of managed care failure to authorize the session who is liable for harm based upon abandonment of the treatment.

• the health care provider
• the managed care company.
• the individual at the managed care company who failed to authorize necessary treatment.
• all of these

Explanation:

🆕 New Concept Discovered: Medical Abandonment Liability
Who is legally responsible when care is cut off prematurely.

Step 1: Understand the duty of care and abandonment

In healthcare law, once a provider-patient relationship is established, the healthcare provider owes a duty of care to the patient. "Abandonment" occurs when a healthcare professional unilaterally terminates this relationship without giving the patient sufficient notice or a reasonable opportunity to find a qualified replacement provider.

Step 2: Analyze the impact of insurance or managed care decisions

Even if a managed care organization (MCO) or insurance company refuses to authorize or pay for further treatment sessions, the ultimate clinical duty to the patient remains with the treating healthcare provider. A financial denial by an insurer does not legally excuse a provider from abruptly terminating necessary medical care.

If the provider terminates treatment abruptly solely because of a lack of payment authorization and the patient suffers harm as a result, the provider can be held legally liable for medical abandonment.

Step 3: Evaluate the options

• The health care provider: This is correct because the provider has the direct, non-delegable clinical duty to ensure the patient is not abandoned, regardless of third-party payment decisions.
• The managed care company: While managed care companies can sometimes face liability for negligent utilization review (e.g., in landmark cases like Wickline v. State of California), the primary liability for the physical act of abandoning active treatment still rests on the provider who chose to stop treating.
• The individual at the managed care company...: Individual employees of an insurance company acting within the scope of their employment are generally not personally liable to the patient for coverage determinations.
• all of these: Since the primary, direct liability for abandoning a patient's active care rests on the provider, this option is incorrect.

Answer:

The health care provider