Compliance October 1, 2002

Supreme Court to Hear Patients' Rights Case

January 10, 2002 (PLANSPONSOR.com) - A case that will lay ground rules for patients unhappy with the doctors in their insurers' networks, and want the networks to pay for treatments following an independent review of their ailments, will soon come before the US Supreme Court.

Reported by

Camilla Klein

Plaintiff Debra Moran, spent seven years searching for a treatment for a pain in her wrist, which eventually became immobile, and forced her to quit her job.

Her doctors first diagnosed and tried surgery, drugs and physical therapy to no avail. Eventually, a surgeon diagnosed the condition as thoracic outlet syndrome, a compression of nerves in the neck, and recommended surgery.

However, Rush Prudential, her insurance company, insisted she be examined by in-network specialists first. Those specialists recommended a different treatment.

Moran demanded an independent review, allowed under Illinois law. An outside expert examined her and agreed the $98,000 surgery was necessary.

Rush paid out, but challenged the Illinois law – the case eventually reaching the Court of Appeals in Chicago, which sided with Moran.

In March 2000, Wellpoint Health Networks purchased Rush, now called Unicare, and decided to appeal to the Supreme Court.

The case is Rush Prudential HMO Inc. v Debra C Moran and State Of Illinois .