PATIENTS CAN SUE THEIR HMOS [ back to What's New ]
On 9/27/99 California passed a law authorizing patients to obtain a second medical opinion paid for by their HMO, and to sue their HMOs for actual and even punitive damages for delaying or refusing treatment in certain circumstances. Governor Gray Davis signed the measure to "make   the health of the patient the bottom line with HMOs, not saving costs." It is anticipated that the fear of being held financially accountable in patient lawsuits for damages, will deter HMOs from always opting for cost savings versus spending extra for quality care. Other states with new laws on the books having some elements of the California reform package are Georgia, Louisiana and Texas. At this time 34 other states are considering legislation to regulate HMO decision making for protection of patients' rights. TBI patients who are denied rehab services on the grounds that they are experimental or unproven, should check with medical and legal specialists to see if they have statutory grounds for a legal challenge.

The California law mandated the creation of a new state agency called the Department of Managed Care based in Sacramento. Complaints about HMOs can be made directly to the Department, which will investigate and respond. The department can be contacted through
http://www.hmohelp.ca.gov/