U.S. High Court blocks state court HMO suits, supports ERISA preemption: two justices say Congress should revisit ERISA, give plan members a better relief mechanism.(Long-Awaited Ruling)(health maintenance organizations, Employee retirement income security act of 1974)

National Underwriter Property & Casualty-Risk & Benefits Management, June, 2004 by Bell, Allison

THE U.S. SUPREME COURT GAVE health care companies a victory last week with a ruling that patients cannot sue in state courts when their health maintenance organizations refuse to pay for doctor-recommended medical care. The decision involved Aetna Health Inc. vs. Davila and Cigna Healthcare Inc.

vs. Calad. Both cases were brought under the Texas Health Care Liability Act, which allows members of employer-sponsored plans to sue carriers over benefits determination decisions that involve questions of medical judgment. Claims of malpractice by a doctor are not affected by the 9-0 decision. In one of the cases at issue, a patient sued Aetna for refusing to pay for a pain-relieving drug for arthritis. The other involved a woman who claimed she suffered...

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