Monday, June 21, 2004

Does Your HMO Still Cover Blood-Pressure Medication? 

For your own good, we suggest you make absolutely certain before you read the following. From the AP wire:
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 . . . .

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 . . . .

"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 . . . .

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.

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