SCUS ruling on HMOs

[Kennedy 0]

So, after this ruling, an HMO can throw you out the day after quadrupal bypass surgery, and when you suffer the expect complications, it's not their fault?

Quote

Court Rules for HMOs in Patient Lawsuits
By MICHAEL GRACZYK, Associated Press Writer

SUGAR LAND, Texas - Leading up to her hysterectomy about five years ago, Ruby Calad thought she understood all the insurance bureaucracy involving her HMO.

"I'd done my homework," the suburban Houston woman said.

But the day after her operation, she was told by a Houston-area hospital she had to be released because her HMO, Cigna Healthcare of Texas Inc., would approve no additional expenses. She was discharged prematurely, then wound up in an emergency room a few days later, she said.

"(It) ended up costing them more money," Calad, 50, recalled Monday, a few hours after learning the U.S. Supreme Court had ruled against her in a lawsuit stemming from her HMO's decision.

"The court essentially looked the other way on the issue of the HMO abuse," she said.

The court said HMOs are shielded from lawsuits in state courts, where juries are more apt to side with victims and recommend multimillion-dollar judgments from insurance companies.

Justice Clarence Thomas, who wrote Monday's ruling, relied on a federal pension benefit law that predates the rise of managed care and said patients may pursue claims only in federal courts, where awards are capped at only the cost of medical services the HMO would not cover.

The ruling means patients like Calad can't seek hefty damage awards in court if their HMOs refuse to pay for doctor-recommended medical care. The unanimous decision rejected arguments that the threat of multimillion-dollar lawsuits keeps insurance companies honest, invalidated an important part of patient rights laws in several states and tossed a political hot potato back to Congress, where lawmakers repeatedly have tried and failed to pass national patient protections.

"I hope this ruling breathes new life into the patients' bill of rights debate in Congress," Calad said. "I'm also hoping they do not just sweep this under the rug and completely forget about it."

The ruling, in a pair of cases filed by Calad and Juan Davila, also of Texas, affects the roughly 72 million people covered by HMOs.

The Texas cases were filed under a patients' rights law passed when President George W. Bush was governor. When Bush was running for president four years ago, he took credit for the law, but his administration sided with insurance carriers when the two cases reached the high court.

In their arguments to the court, lawyers for Cigna noted that Calad's health care plan at the time, like most other health benefit plans, "does not promise to cover any and all health care sought or desired by beneficiaries."

The Supreme Court did not decide whether the plaintiffs deserved better, only whether and where they could sue.

"As far as I know, it's dead," Calad said of her legal challenge. "I would do it again. it was worth the fight."

witty subliminal message
Guard your honor, let your reputation fall where it will, and outlast the bastards.
1*

[newsstand 0]

You are causing confusion in my liberal brain. GWB was against this as GOV., then behind it when he saw it as inevitable, touted it as a candidate and now opposed as president and it would seem you disagree with his current position.

Forgive me if I am mistaken but I see you as a Bushie, right or wrong.

"Truth is tough. It will not break, like a bubble, at a touch; nay, you may kick it about all day like a football, and it will be round and full at evening."
-- Oliver Wendell Holmes

[Kennedy 0]

Normally I'm the first one to step up and throw down on lawsuit lawyers. However, don't think that means I'm going to turn my head when some GD MF CS POS bureaucracy is screwing people.

Also, I don't really like the republicans all that much more than democrats. They really are opposite faces of the same coin. Each wants to give you some freedoms while mandating government control over others, while socializing damn near everything. Both fail to realize that there is no such thing as "freedoms." The word cannot be plural. By restricting any you restrict all.

Personally, I tend slightly towards conservative politics, but in capping government power, I am wholeheartedly libertarian.

ps - lately the democrats have been fucking with my priorities more than the republicans, but don't think I'm a "bushie" any more than you are a "dittohead." Some of us are still capable of original and independent thought.

edit: I agree many settlements should probably be capped, but when a person is tossed a day after surgery and suffers that much more time off, that many more procedures, and that much more pain, they deserve more than the cost of the medical attention they were denied.

witty subliminal message
Guard your honor, let your reputation fall where it will, and outlast the bastards.
1*

[newsstand 0]

Quote

lately the democrats have been fucking with my priorities more than the republicans, but don't think I'm a "bushie" any more than you are a "dittohead." Some of us are still capable of original and independent thought.

Thank God for that.

"Truth is tough. It will not break, like a bubble, at a touch; nay, you may kick it about all day like a football, and it will be round and full at evening."
-- Oliver Wendell Holmes