HMOS--independent medical review--preemption. Rush Prudential HMO, Inc. v. Moran.
A state statute can require an HMO to provide for an independent medical review of a denial of a request for a particular treatment as not medically necessary and to provide the treatment if the reviewing physician determines the covered service is reasonably necessary. The statute is exempt from ERISA preemption as a law that regulates insurance.
D019461:Employee Retirement Income Security Act / Q000331:legislation & jurisprudence*; D006279:Health Maintenance Organizations / Q000331:legislation & jurisprudence*; D006801:Humans; D007345:Insurance Claim Review / Q000331:legislation & jurisprudence*; D020380:Needs Assessment; D018024:Peer Review, Health Care; D014481:United States