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David Trueman sees himself as a thorn in the side of managed care, one of the few lawyers trying to hold the emerging industry accountable for its vast and growing power. "There aren't many of us out there," says the 48-year-old attorney, who practiced clinical psychology for more than two decades before he started law school in 1994. Still a working psychologist, Trueman knows there is no shortage of managed-care outrages begging legal solutions; even his own patients have been denied care by the latest generation of insurers.
Big personal injury firms, Trueman notes, have yet to show much interest in what he calls the "very fledgling" field of managed-care law because there isn't a lot of money in it. Throughout the country, suits over wrongful denial of benefits are stymied by a federal law that shields employer-sponsored insurers. And in New York Trueman has offices in Midtown and on Long Island HMOs and other insurers have also used the state's public health law to further stave off liability.
According to that state law, managed-care companies are not technically practicing medicine, so patients have had difficulty suing them for medical malpractice. Just over a week ago, what may be the first malpractice suit against a managed-care company was allowed to go to trial, getting past the defendant company's motion to dismiss.
Trueman thinks he, too, has what it takes to make legal history. He has just begun filing his first wrongful-denial cases against managed-care companies. So far, none of these kinds of cases have been won in New York. But Trueman is hoping that he can show clearly that the companies have harmed his clients and violated their own rules. One of his cases concerns a mentally ill woman whose insurer denied her in-patient coverage, a decision that Trueman claims led to her being hospitalized on an emergency basis, and then to becoming temporarily homeless. Diane Kopitowsky, the woman's mother, says she called 20 lawyers, but only Trueman was willing to take it without charging by the hour.
If he manages to survive the inevitable legal hurdles ahead, then he will likely have established legal precedent in the state. "Then you've made law," Trueman says excitedly. "It could be exceptionally good for consumers."
While he and other lawyers are waiting for the legal dam to burst, Trueman has had to settle for being little more than a glorified bill collector. The bread and butter of his practice are attempts to convince companies to provide his patients with services, and efforts to track down illusive reimbursement checks for both patients and providers. Trueman says he's handling more than 50 such cases, sometimes on contingency, sometimes charging on a sliding scale that often dips toward zero. Because he frequently comes up empty-handed in even these more mundane matters, he sometimes has to rely on income from his psychology practice and the occasional divorce case he handles.
But for Trueman, who says he's a " '60s guy" at heart, the money isn't the point or at least not the main point. Though he has a financial stake in fighting the system, Trueman insists principle drives his crusade against managed-care abuses. "I really find it despicable that organizations interested in making money are now compromising health care," he says. "We shouldn't allow money to be the decision-making power about human values."
This being the '90s which Trueman notes are sort of like the '60s turned upside down he set up a website (www.truemanlaw.com) to express his particular mix of political activism and self-promotion. On it, disgruntled patients and health care providers can find tips on how to take on the big guys. Visitors to the site can link up to advocacy groups that lobby for laws to make HMOs more accountable and learn the importance of documenting all interactions with their insurers. Trueman even recommends recording calls with managed-care companies (though notes you should notify the comapny you're doing so). And, of course, with the click of a little "If You Are Injured" button, they can quickly reach the lawyer himself.
Which is not to say that Trueman is an ambulance chaser, a term that makes him bristle. He does sometimes hand out his brochures at health care speak-outs and other places he's likely to find aggrieved patients. And he is considering running ads on local cable stations and in the subways. But many among his fast-growing clientele have found him by word of mouth.
And, unlike some of his grittier fellow barristers, Trueman has a mission. Until the Big Case or new laws close the legal loopholes he's content just to send his message to the hulking managed-care Goliaths: "I want to tell them that you can't deny people just because you want to save money. They should know you can't just jerk people around."