Hughes v. Blue Cross of Northern Cal. So in 'conscious disregard' of pt's rights. Fox v. HealthNet, Civ. Person who denied rx was paid by how much he saved. Specific procedures are not spelled out in the contracts.
Definition is unilateral, ad hoc, and often self-serving.
Nothing to prevent HMO classifying appendectomy as experimental. No procedure for external appeal. Accordingly, defendant was required to cover the costs of the treatment. Unconscionability Factors Cal. No bargaining possible.