I filed a claim against my HMO, and now they want me to go to arbitration. Should I say yes?
You may not have a choice. Your HMO contract may require that you participate in arbitration, a private process in which a neutral arbitrator hears the evidence and decides your claim. Many Health Maintenance Organization (HMO) plans contractually require patients to arbitrate all disputes above a certain dollar level to a binding resolution, which means you must accept the arbitrator’s decision. If you have questions about whether you must arbitrate a dispute, you should ask your HMO to provide you with a copy of the arbitration clause.
If your policy contains a mandatory arbitration clause, you will not be able to go to court if a dispute arises. The clause itself will spell out how arbitrators are selected. The Federal Arbitration Act requires the process to be fair and reasonable.
If your plan contains no arbitration clause, and the HMO is suggesting voluntary arbitration instead of a lawsuit, you should contact a lawyer specializing in insurance and medical benefit claims to counsel you on the issue. If you agree to arbitrate, you will be giving up the right to have a jury decide your claim — something you may not wish to do.
In general, once a dispute has reached the point where you or the HMO is considering either a lawsuit or arbitration, you should consult a lawyer. Although arbitration is less formal than a lawsuit, it is sufficiently complex that consumers who are not trained in the law may be at a serious disadvantage to their HMO without appropriate professional advice.