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July 14, 2002 at 08:00 PM
Patients Rights Revisited
With coverage decisions by managed care companies potentially skewed by dollars and cents issues, rather than driven solely by medical necessity, 42 states have determined that it is only fair for people to be able to challenge the decisions of their health insurers before an independent third party.
A states right to guarantee claimants such an appeal is not preempted by the Employee Retirement Income Security Act, according to a decision by the U.S. Supreme Court in Rush Prudential HMO v. Moran.
Now that this matter is no longer open to debate, there should be even more pressure put on Congress to level the playing field and clarify any further ambiguities by passing a comprehensive Patients Bill of Rights.
The Supreme Courts decision leaves patients in eight states without the protections from overzealous or unscrupulous managed care administrators accorded to citizens in the other 42. In addition, millions of workers at firms whose health coverage is provided by self-insured employers are not covered by the decision, leaving them at the mercy of their plan managers.
