• FreeAdvice has a new Terms of Service and Privacy Policy, effective May 25, 2018.
    By continuing to use this site, you are consenting to our Terms of Service and use of cookies.

Can I sue an HMO dr. or an insurance co.?

Accident - Bankruptcy - Criminal Law / DUI - Business - Consumer - Employment - Family - Immigration - Real Estate - Tax - Traffic - Wills   Please click a topic or scroll down for more.



I was hospitalized after an ER visit for a full week last spring. Several tests were performed during that week. My HMO dr. had to give referral fro the visit; as such, everything that took place thereafter in the hospital was to be 100% covered. Since that time, I have received a 1/2" high stack of bills from various dr.'s, plus numerous hospital bills. Eventually, most get paid by the insurance co., but NOT A SINGLE ONE was paid correctly the first time. This has caused me countless hours of trying to straighten things out that should have been very, very simple, and the bills are still coming. The offices that send the bills always have different stories than what the insurance co. tells me about why this or that was denied or not paid in full. It seems that the insurance co. tells them one thing & me another sometimes. Sometimes the insurance co. tells me that the problem lies with the primary care dr. - they sometimes say that he did not follow proper protocol in getting referrals out.
This would not surprise me; that particular dr.'s office was nothing but trouble for me & I have since switched doctors. That dr. never gave me my CAT scan results, even after I called & requested this several times. The office staff is terrible; I hear complaints all the time from patients at my office (I work at a dr.'s office). The dr. never called or visited me during the week I was hospitalized. They do not really answer their phones - it always goes straight to voice mail, and then the often do not return calls. It's not just me - as I said, I hear this from others, including from other dr.'s. You know it must be really bad when other dr.'s will badmouth that office freely.
Anyway, the reason I was hospitalized in the first place was a heart problem. The whole ordeal might have been prevented if the dr. had followed up after my CAT scan & directed me for treatment or further evaluation. Now it's possible that this same dr.'s office may be responsible for the insurance problems I am having.
I lost a week's pay over this, plus several other costs & have had hours & hours of aggravation, which by the way, has gotten so extreme that it has driven me to tears of frustration (I am not really all that emotional!) and has even caused me chest pain & palpitations!
I am at the end of my rope & don't know where to turn. I've heard that an HMO doctor cannot be sued; true???
How can I determine just who is at fault for my problems, and can I sue the dr. or can I sue the insurance co.?



I am a law school graduate. What I offer is mere information, not to be construed as forming an attorney client relationship.

I haven't read your facts, but based on your question: you sue both if based on medical malpractice.

The court will then determine (via the arguments presented by attorneys on each side) who is at fault and then issue a judgment accordingly.

Find the Right Lawyer for Your Legal Issue!

Fast, Free, and Confidential