Understand Your Rights in an HMO Claim
Can you sue your HMO (Health Maintenance Organization)? Maybe, but you're going to need help.
HMOs are considered to be an employee benefit plan that falls under the FEDERAL Employment Retirement Income Security Act of 1974 (ERISA) and for that reason, many courts have made it difficult to sue HMOs for negligence or malpractice because state law doesn't apply to these plans. Put simply, your only option might be to file a suit in your state's court system against the physician, but not the HMO. It just depends on the state.
This sounds complicated because it is. Some states hold HMOs & their employees responsible for patient harm when they have failed to provide basic care or make timely treatment decisions. Some states do not. Some states prohibit HMOs from dropping physicians from their contracts because they sided with a patient. Some states allow those physicians to be removed from the list of participating doctors and panels.