Supreme Court may rule on expanding patient protection rights

The high court asks the new administration for its views on the increasingly popular state independent medical review laws.

By Tanya Albert, AMNews staff. Jan. 29, 2001.

Physicians will soon get a glimpse of how George W. Bush's administration views expanding patients' rights against health insurers.

The U.S. Supreme Court asked the Justice Dept. earlier this month for its views on whether states can require independent medical reviews when health plans and patients disagree on medical necessity.

The Supreme Court hasn't accepted the case -- which challenges a Texas law allowing a review. But the request for the government's opinion indicates that justices may be interested in taking up an issue that recently has been at the top of state and federal agendas.

A ruling from the high court could affect nearly 40 states and the District of Columbia, which have passed independent or external review laws. More than a dozen of those states adopted laws in the past year.

"This is certainly a major issue on the state level, and many states are taking action," said Richard Cauchi, senior policy specialist with the National Conference of State Legislatures. "Part of this whole question is, "What can a patient or a consumer do?' "

When it comes to independent review, there are conflicting federal court answers to that question.

The U.S. Court of Appeals for the 5th Circuit last summer struck down a Texas 1997 independent review law. The court, whose jurisdiction covers Louisiana, Mississippi and Texas, said the law conflicted with the federal Employee Retirement Income Security Act of 1974 that has its own review process. The ruling affects only employee-sponsored health plans that are protected by ERISA. [...]