Supreme Court and HMO's

[ShinyTop]

The Supreme Court has ruled that individuals do not have the right to sue HMO's when they have been denied needed treatment or otherwise harmed by financial decisions of the HMO. You can read CNN's article (http://www.cnn.com/2004/LAW/06/21/hmos/index.html).

As I understand it the SC used a 30 year old law designed for another purpose to deny individual states the right to allow such law suits. While not sure of, and not qualified to adequately discuss, the exact issues I do understand that organizations doing business nation wide should be able to expect some consistency.

Now that the SCOTUS has made a decision it is time for Congress to come to the fore and take care of its citizens with a Patient Bill of Rights that holds HMO's responsible when they make bad decisions. I am very afraid this decision leaves us all very vulnerable to medical decisions made in the interest of saving the HMO money rather than our health.

While firmly believing it necessary for Congress to act I do not expect any action to result in anything approaching adequate protection for HMO customers. Our elected officials from the White House through the Senate and House are owned lock, stock, and barrel by big contributors, with the health industry being right up with the leaders of big contributors.

Am I too jaded, too pessimistic? I hope so. And in that interest I challenge the Administration and Congress to prove me wrong and pass effective legislation that protects the public while allowing insurance companies to make a fair profit. Show me and the nation that you are as smart and as cognizant of the needs of the American people as you claim when running for office. I am waiting.

[bruzzes]

Great link!

[BigDeputyDog]

The decision was that the HMOs could not be sued in State courts, where judgements can be quite high. The HMOs are to be sued in Federal court.

BDD...

[Stiofán]

Yes. I don't like HMOs, won't have one myself, and rarely recommend them to my clients.

[LissaKay]

True, BDD ... but in Federal court, awards would be limited to the cost of medical treatment the HMO denied.

Uhh ... yeah.

[Neo]

The Supreme Court has ruled that individuals do not have the right to sue HMO's when they have been denied needed treatment or otherwise harmed by financial decisions of the HMO.

As I understand it the SC used a 30 year old law designed for another purpose to deny individual states the right to allow such law suits.

Now that the SCOTUS has made a decision it is time for Congress to come to the fore and take care of its citizens with a Patient Bill of Rights that holds HMO's responsible when they make bad decisions.

While firmly believing it necessary for Congress to act I do not expect any action to result in anything approaching adequate protection for HMO customers.

You have nailed it pretty much on all counts in the edited by me for brevity portion of your post quoted above.

The ruling was strictly a legal one that says the issue is covered by a Federal Law known as ERISA and that it supersedes any state law as matter of law. The ruling is not a comment on the effectiveness or value of ERISA.

In fact the vote was 9-0 and I am not sure but I don't think there were any dissenting opinions of the legal merits.

IMO this is bad news for individuals and good news for HMOs and employers.

HMOs are funny ducks. If run in good faith by competent people HMOs can be the best of the health care offered overall in this country WHEN they are linked to a well run heath care provider within the HMO system. I am alive today because of such an HMO system combined with a non-profit health care provider and Medical Center. But the combination I describe is unique, especially in that in the burden for quality of service is placed upon the provider contracted with the HMO. So two people can have the same HMO, say for instance Blue Cross. But one persons provider his Acme Medical Group and the others is St. Joseph's Medical Group and Center. The former get treated like an animal while the latter gets treated like St. Josephs is run by the same folks that run the J.W. Marriott Luxury Hotels.

And on a national basis the people who are really hurt are those who have large mega in house HMOs like Kaiser, where Kaiser is both doctor, judge and jury so to speak. An inherently flawed system and now by this ruling insulated further from accountability.