The HMO refused because the center was out of its service area. Eventually it agreed, but by then Kuhl's disease had progressed so far that a transplant was his only hope. The HMO again refused and he died, waiting. It covers all employee benefit plans, including health plans. It's a state issue.
Malpractice goes away.
Patients with individual health insurance can bring malpractice suits against HMOs. The law has limited only those in employer plans. These same prohibitions apply to disability insurance bought through employer plans. Had Nelene Fox been Buddy Kuhl, her case would have been thrown out of court. You can still sue a doctor for malpractice, if he or she misdiagnoses you or mishandles your case.