Business Services Industry
HMO that fought Texas law battling to restore provision. (Aetna U.S. Healthcare)
Business Insurance, September, 1998 by Wojcik, Joanne
AUSTIN, Texas - Aetna U.S. Healthcare is trying to save part of the Texas managed care liability law it challenged in court. When U.S. District Court Judge Vanessa Gilmore upheld the 1-year-old Texas statute permitting patients to sue health maintenance organizations for malpractice, she also struck down the part of the law creating an independent review process for treatment denials.
Ruling in Aetna U.S. Healthcare vs. the Texas Department of Insurance, the judge said the state's external appeals program violates the federal Employee Retirement Income Security Act of 1974. The statute called for the creation of an independent review organization. It is run by the state Insurance Department and reviews any case in which a person was denied coverage or has a...
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