MrRant 0 Report post Posted June 21, 2004 By ANNE GEARAN, Associated Press Writer WASHINGTON - Patients can't seek fat damage awards in court if their HMOs refuse to pay for doctor-recommended medical care, the Supreme Court ruled Monday, rejecting arguments that the threat of multimillion-dollar lawsuits keeps insurance companies honest. The unanimous decision invalidated an important part of patient rights laws in several states and tossed a political hot potato back to Congress. Lawmakers have tried repeatedly and failed to pass national patient protections. The last and most promising effort foundered on a wronged patient's right to sue. Health insurers argued to Congress and again in the Supreme Court that enormous jury awards drive up the cost of health care for everyone and might lead some employers to drop their health plans. The court said HMOs are shielded from lawsuits in state courts, where juries are more apt to side with victims and order up multimillion-dollar judgments from insurance companies. Relying on a federal pension benefit law that predates the rise of managed care, the court said patients may pursue claims only in federal courts. There, awards are capped at only the cost of medical services the HMO would not cover. The ruling affects the roughly 72 million people covered by HMOs. It applies to a gray area of medicine and insurance, in which decisions about what treatment to pursue and what coverage to offer are mingled. The situation arises frequently in managed care, where doctors belong to a closed network overseen by administrators, who may not be doctors but who nonetheless decide what the company will pay for. "By reserving the right to decide what is — and what is not — medically necessary, managed care plans can now practice medicine without a license, and without the same accountability that physicians face every day," the American Medical Association said afterward. Democrats on Capitol Hill also denounced the ruling, and presumptive Democratic presidential nominee Sen. John Kerry (news - web sites) said he will make it a campaign issue against President Bush (news - web sites). The justices rejected lawsuits filed by two Texas patients who claimed they suffered avoidable pain and complications because their HMOs pinched pennies. They brought suits under a Texas patients' rights law passed when Bush was governor. During the 2000 presidential contest, Bush took credit for the law. When the issue reached the Supreme Court, however, the Bush administration sided with insurers. Juan Davila, who sued Aetna Healthcare under the Texas patients rights law, took what he claims was inferior pain medication instead of the Vioxx his doctor had recommended because Aetna Health would not pay for the more expensive drug right away. The cheaper medication caused bleeding ulcers, and he almost had a heart attack, Davila said. "My life is not the same and may have been cut short because of the HMO's decision to play doctor," said Davila, a post-polio patient. The Supreme Court heard his case alongside that of hysterectomy patient Ruby Calad, who claimed that Cigna Healthcare of Texas turned her out of a Houston hospital after only one day of recovery. The HMO would not pay for a longer stay, even though her doctor recommended it. She was back in the emergency room a few days later, suffering complications she claims could have been avoided had she remained hospitalized longer after surgery. The Supreme Court did not decide whether Davila and Calad deserved better, only whether and where they could sue. Insurers and business groups had argued that the 1974 Employee Retirement Income Security Act, or ERISA, trumps state patient protection laws that would allow patients to sue over allegedly negligent coverage decisions. ERISA was supposed to protect worker benefits while guaranteeing employers uniform national rules and a streamlined process of handling lawsuits or complaints. Calad and Davila could have brought their lawsuit under ERISA's rules but chose not to, Thomas wrote. Their lawsuits "are completely pre-empted by ERISA," he said. In a statement after the ruling, Aetna called it a "reaffirmation of the law applicable to employer-sponsored health plans." "By affirming the role of ERISA in employee benefits the court has helped to assure that millions of working Americans will continue to have access to quality health coverage provided by their employers," the insurer said. At least nine other states have laws similar to the Texas statute: Arizona, California, Georgia, Louisiana, Maine, New Jersey, Oklahoma, Washington and West Virginia. The cases are Aetna Health Inc. v. Davila, 02-1845 and Cigna Healthcare of Texas Inc. v. Calad, 03-83. Share this post Link to post Share on other sites
NoCalMike 0 Report post Posted June 21, 2004 HMOs are wretched......that is all. Share this post Link to post Share on other sites
Guest CronoT Report post Posted June 21, 2004 HMOs are wretched......that is all. Watch the movie John Q. The very sad truth is, it's not that far from what really happens day to day. Share this post Link to post Share on other sites
Guest Cerebus Report post Posted June 21, 2004 HMOs are wretched......that is all. Watch the movie John Q. The very sad truth is, it's not that far from what really happens day to day. Wrong. First,d octors do not make medical care decisions based on a patient’s ability to pay. In fact, it’s illegal to deny emergency care even if someone can’t pay for it. Second, hospitals do not discharge patients that are near death, but are underinsured. Everyone is underinsured to one degree or another. Third,the reality is that Washington's son would have probably died even if he were on a transplant list. This is because of how rapid his condition deteriorated (done to fit the film), and how long the organ donor lists are. Getting on an organ donor list does not mean you will receive a new heart, lung, liver, etc before it’s too late. There are pleanty of faults with the American healthcare system. Too bad John Q ignored them. Share this post Link to post Share on other sites
NoCalMike 0 Report post Posted June 21, 2004 HMOs are wretched......that is all. Watch the movie John Q. The very sad truth is, it's not that far from what really happens day to day. Well yeah, I have seen the movie. I have a tiny bit of experience in dealing with HMOs relating to treatment of family members and such. Share this post Link to post Share on other sites
OldSchoolWrestling 0 Report post Posted June 21, 2004 I worked for an HMO for 10 years and I had to get out because we were seriously risking people's lives to save a buck. Share this post Link to post Share on other sites
kkktookmybabyaway 0 Report post Posted June 22, 2004 Watch the movie John Q. I did, and I never thought I'd say a film that stars Denzell and Rob Duvall would suck so badly... Share this post Link to post Share on other sites
NoCalMike 0 Report post Posted June 22, 2004 Watch the movie John Q. I did, and I never thought I'd say a film that stars Denzell and Rob Duvall would suck so badly... The film had a lot of flaws, especially the fact that John didn't stop to wonder if a guy ahead of his son on the list decided to do the same thing. I mean the movie was just one big exaggeration. It was ok if you could suspend reality. Share this post Link to post Share on other sites
kkktookmybabyaway 0 Report post Posted June 22, 2004 Or if you are a commie... Share this post Link to post Share on other sites
Guest CronoT Report post Posted June 23, 2004 Or if you are a commie... Hello, Senator McCarthy. I was wondering when you were going to get out of hell. Share this post Link to post Share on other sites
