NU Online News Service, June 20, 4:34 p.m. – The American Association of Health Plans, Washington, has put out a statement by Karen Ignagni, its president, suggesting that today’s U.S. Supreme Court decision on Prudential Rush HMO Inc. vs. Moran et al. is not a total loss for health maintenance organizations and other managed care companies.
“The Court upheld an Illinois law requiring HMOs to provide a procedure for a second opinion regarding questions of medical necessity,” Ignagni says in the statement. “This decision makes more difficult the goal of a uniform independent review process to protect patients.”
But Ignagni points out that the Supreme Court ruling continues to recognize the strict limits that the Employee Retirement Income Security Act of 1974 places on state regulation of employee benefit plans.
“In broad terms,” Ignagni says, “today’s decision by the Supreme Court reaffirms the preemption of ERISA remedies over state law.”
Ignagni also recommends that the country take a national approach to establishing any external review systems.
“Health plans and employers have been at the forefront in supporting external review as a way to resolve disputes over health care coverage,” Ignagni says, but she adds that “patients deserve to know that decisions about their health care are based on uniform standards, and guided by the latest and best medical evidence — no matter where they live.”