HMO’s Neglect Leads to Double Amputation, HMO’s Arbitration Means No Justice

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® Patient’s Medical History: "My HMO’s poor treatment of me led to my suffering a double amputation, a couple of strokes and the loss of both of my kidneys. I am now a shell of my former physical self. I have been ruined financially, yet I have no legal relief against my HMO because of the current state of the law, which overly protects HMOs."

SUNLAND, CA- "In addition to the very poor medical treatment I received, my HMO mistreated my wife and I when I made a claim for damages. Unaware that we had signed away our right to go to court when we enrolled, I was forced into binding arbitration with my HMO.

From the beginning, my HMO mistreated us in arbitration. Although we made many phone calls to the HMO’s legal department, our calls were never returned. They also never returned my lawyer’s numerous calls.

Furthermore, my HMO refused to give me copies of my medical records after they realized I was planning to make a claim. I finally received some (but not all) of my medical records, but only after I hired an attorney who subpoenaed the records. I incurred substantial costs in getting these documents. Even then, my HMO did not release all of my records.

My lawyer eventually dropped my case when he realized the obstacles caused by taking on the HMO. No other lawyer wanted to take on my case, leaving me without legal representation for the rest of the arbitration.

Next, when I provided documents to the HMO’s lawyer, she promised to copy the documents and return them the next day. Despite numerous requests my documents were not returned to me for three weeks – not leaving me enough time to respond to the HMO’s motion for summary judgment. All of these tactics by the HMO’s lawyers were allowed by the arbitrator. It felt like it was me against the two of them.

The HMO then refused to postpone the summary judgment motion. As a result in part of this tactic, I lost the motion and the arbitrator’s judgment was entered in favor of the HMO.

After the decision of the so called ‘neutral’ arbitrator, the arbitration company mailed me the decision in an empty envelope. After receiving the empty envelope I made numerous phone calls to them but they never returned my phone calls. After receiving no response from the ‘neutral’ arbitration company, I decided to write them a letter stating my displeasure with the decision. Later on I found out that they considered that letter as an acceptance of the decision and I had closed all my avenues for a fair hearing and justice.

This type of conduct by the HMO’s attorneys and the arbitration was clearly unfair and unethical. As my health care provider and insurer, my HMO at least had an obligation to deal with me fairly. It appears that the HMO believed that it could get away with this type of conduct because of its protected legal status as an HMO. The HMO knows it can manipulate the arbitration in its favor. Now I have no other avenues for a fair hearing or justice.

I want to see the laws reformed so that HMOs are obligated to treat their patients fairly and are held financially responsible for their behavior. Their protected legal status and unfair arbitration system has led to many cases of abuse such as mine.

These types of abuses will continue until HMO’s are held accountable. The so called ‘neutral’ arbitration was very unfair. They even refused to give me a month extension so my lawyer from Dallas, Texas could study my file and let a doctor outside California study my medical file.

These arbitrations are weighed in the HMO’s favor. There needs to be a way to make this public and let patients appeal an arbitrator’s decision."

— Misac Negosian reports his own story.

FTCR will continue to fax daily a story of HMO Arbitration Abuse to educate the public on the need for reform. AB 1751 (Kuehl) makes HMO binding arbitration voluntary rather than mandatory.

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