Compliance March 1, 2003

Patient's Rights Case Pending

January 15, 2002 (PLANSPONSOR.com) - Tomorrow the US Supreme Court will hear arguments in a case that will clarify whether the Employee Retirement Income Security Act (ERISA) pre-empts state laws requiring an independent external review of health care claims decisions.
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The case of Rush Prudential HMO, Inc. v Moran orginated when Debra Moran originally file suit against in the HMO in 1997 in Illinois.

After searching for several years for a treatment for a pain in her wrist, Moran consulted with a physician outside of her plan’s network of doctors and underwent a $98,000 surgery.

Rush Prudential shelled out the money for the surgery but challenged Illinois law. The case eventually reached the Court of Appeals in Chicago, which sided with Moran.

Under Illinois’ independent review statute HMOs are required to submit disputed medical coverage determinations to a physician outside of its network for review. 

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