June 22, 2004

HMO's protected by Supreme Court ruling. Americans who get health insurance through their employer are no longer entitled to damages for any harm they suffer when their HMO improperly denies coverage for recommended medical care, the U.S. Supreme Court ruled Monday. A boon for cutting down on rampant litigation or a removal of checks and balances on HMOs?
  • This is awful. Simply reading the examples in the article makes that clear. And I'm again struck by how people will accept such terrible service from private health care, abuses that would have those in public systems up in arms. There has to be some kind of accountability by the HMOs to the public.
  • It's not called the Supream Court for nothing.
  • This decision was disconcerting as well. What about Miranda Rights? Rights against Self-Incrimination? And what happens if you decide not to give your name? How might officers convince you to change your mind?
  • are no longer entitled to damages for any harm they suffer when their HMO improperly denies coverage "...ruling in effect that patients can't bring multimillion-dollar lawsuits when insurers refuse to pay for recommended medical treatment." -opening sentence of the article. the second sentence states that this ruling is for state courts.
  • This decision was disconcerting as well. Some call it an "apocalyptic constitutional moment," the implications of which are not widely understood. But I agree with Professor Froomkin that the Hibel case is important but not as serious as The Big One, which has yet to be decided.
  • There's a difference between federal and state courts regarding monetary rewards. The HMO case has to do with whether or not you can sue them for malpractice (ie they are health care providers) in a state court, where damages can be awarded for more than just the cost of the service denied. The laws were established when there was a clear division between the insurer and the provider, but HMOs blur that line by making decisions about care as well. Currently, most of these lawsuits against insurers can only be brought up in federal court (where you are rewarded the cost of service denied only). Something like that. I just answered an exam question about this a month ago, so I hope I remember it correctly.
  • I'm coming back to this after a while, but it is a very interesting topic. blogRot: I thought pretty much the same thing as you when I began reading - that it would only prevent disproportionately huge suits (which are a disgrace). But in reading the examples I realised it was more serious. It's been a while since reading, but I believe that the examples and the articles made the distinction (as mandyman helpfully did) between federal and state courts. I believe that it is such that if you are denied treatment A and die, are incapacitated, or severely disabled as a result thereof, in state court you could sue for damages to help support you or your family through the hardship you now suffer through their negligance. But the federal court can only award as much as the original treatment, though it is, of course, too late for that treatment. This gives HMOs more protection than doctors regarding malpractice. I personally find that offensive because most doctors' bad decisions are as a result of honest mistakes, whereas the HMO is making a bad decision purely on monetary grounds. But more seriously, it leaves the field open for HMOs to deny all sorts of treatment to their patiens, gambling on peoples' lives - and they can't loose. They can only be told to pay for the treatment they would have paid for otherwise. Whereas the person's life may have been lost or ruined.