Davis v. GHS Health Maintenance Organization, Inc.

KAUGER, J.;

T1 We retained this cause to determine whether pursuant to 74 O.S. Supp.1997 § 1366(B), 1 74 O.S. Supp.1992 § 1372 2 and OAC 87:1-5-10 (1994) 3 an insured, who has not received full payment for disputed medical expenses, must exhaust administrative remedies before filing a bad faith suit in district court . 4 Title 74 O.S8. Supp1992 § 1372 5 and OAC 87:1-5-10 (1994) 6 require HMOs denying claims to advise insureds of the right of appeal and the name of the entity from whom review may be requested. Because the HMO did not inform the insured of review or appeal rights in its denial…