Supreme court upholds state independent review laws: does this help or hinder health plans?
"U.S. Supreme Court Deals Blow to HMOs," trumpeted the CNN headline on June 20, 2002. In Rush Prudential HMO, Inc. v. Debra C. Moran, the United States Supreme Court ruled that state laws requiring external review of health plan/HMO decisions regarding medical necessity of covered services did not violate the federal Employee Retirement Income Security Act and were therefore enforceable. If the media is to be believed, requiring HMOs to give second opinions, i.e., external review, is a major blow. However, a review of the case and the fact that the decision was based on a 5-4 vote reveal that lasting lessons from the decision are probably fewer than the press would have one believe.
Bloom
Alan
A
Maxicare Health Plans, Manhattan Beach, California, USA.
D019461:Employee Retirement Income Security Act; D006279:Health Maintenance Organizations / Q000191:economics / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D006801:Humans; D007087:Illinois; D007345:Insurance Claim Review / Q000331:legislation & jurisprudence*; D007349:Insurance, Health, Reimbursement / Q000331:legislation & jurisprudence*; D014481:United States