GOVERNMENTLawsuits against health plans crumble in wake of Supreme Court rulingFederal appeals courts in New York and Georgia have dismissed cases that they originally said could go forward.By Tanya Albert, amednews staff. Nov. 15, 2004. Worries in the physician community that a Supreme Court ruling would undermine patients' ability to sue their health plans are starting to become reality. Two federal appeals courts recently reversed decisions that originally gave subscribers the right to go forward with such cases. The rulings both take into consideration the high court's June decision that Texas patients could not proceed with their HMO lawsuits. The Supreme Court in Aetna Health Inc. v. Davila said the federal Employee Retirement Income Security Act of 1974 pre-empted the Texas law allowing health plan liability cases and, as expected, lower courts are now following suit. Ten other states have similar laws. "The fallout is that patients only have limited remedies when these companies make negligent decisions to deny necessary care," said Donald J. Palmisano, MD, American Medical Association immediate past president. "It's a loss for patients." The insurance industry says the Davila ruling and the decisions that followed are positive for patients. "We were always concerned about the possibility of every benefit determination being turned into an expensive lawsuit," said Susan Pisano, spokeswoman for America's Health Insurance Plans. "ERISA was designed to protect consumers through prompt and fair settlement of claims." Pisano and some legal experts noted that patients who disagree with a health plan have recourse through external and independent review laws that many states have passed. [...]Full text of American Medical News content is available to AMA members and paid subscribers.
Copyright 2004 American Medical Association. All rights reserved.
|
Feature articlesHealth reform review The Massachusetts experience Litigation stress Being sued is personal as well as professional Comprehensive coverage
Most-viewed
Nov. 9 issueHouse passes health reform bill, debate moves to Senate New database for out-of-network pay set to replace disputed Ingenix system Columns and series
From the vault: 5 years agoGenetic testing issues land in primary care practices Nov. 8, 2004 
|
SHARE
