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. Suppliers must apply to be part of the network. For a provider to become an in-network provider, they must have specific credentials proving that quality of care will be assured. This ensures that providers meet care requirements and are less likely to have malpractice issues. However, if they encounter any problems, they should have malpractice insurance to cover them. HMOs screen potential providers before approving them for inclusion in the network because of the responsibilities that may fall on the HMO for approving that provider. (DiCicco, 1998) HMOs help reduce unnecessary visits to emergency rooms and specialists by requiring a referral from their primary care physician. This reduces costs and delegates patients to the appropriate providers; however, this can be difficult for patients who need care more quickly than they can get through the referral process. Assigning, receiving and processing referrals can be a lengthy process for large practices, which can cause strain on staff members as well as patients waiting for referrals to seek further treatment. (Steele, 2013).Say no to plagiarism. Get a tailor-made essay on “Why Violent Video Games Should Not Be Banned”? Get an original essay. An example of this process causing a medical crisis for patients and malpractice suits against the provider is the case of Boyd v. Albert Einstein Medical Center in 1988. A patient needed a biopsy and after receiving the test, she was further injured, which continued to get worse. Because she had an HMO, she returned to the primary provider from whom she had initially received a referral, but that was not enough. This patient needed emergency care to which the provider did not refer her. Instead, she underwent tests that would take days to receive the results of. If she had been transferred to the emergency room, she could have gotten her test results sooner and possibly a different health outcome. The patient lost her life due to the negligence of the provider performing the tests, knowing that the results would not be available in a timely manner. (Hall and Orentlicher, 2013, p. 129). HMOs must carefully monitor their referral and denial actions, to avoid risking a case of HMO negligence. The reasons why these cases may be mentioned are: Refusing necessary diagnostics in life-threatening cases. Reuse referral requests that are necessary (including from out-of-network providers, if necessary) Refuse to transfer a patient to another facility when necessary (if the current facility cannot provide the required diagnoses or treatments ) Refusal to request a second opinion from external service providers when a network service provider is not sufficient. There is a possibility of legal action against the HMO in these situations. resulting in the loss of a patient's life, as well as bad faith suits for denial of claims that should have been paid without issue. An insurance company cannot deny covered routine services without reason. A legitimate reason must, 2011).