HMO Coverage Decisions
Contesting "Medical Necessity" of Out-of-Network Treatments
Excerpt
The court will decide whether the Employee Retirement Income Security Act (ERISA) preempts state laws regulating HMOs. The outcome could determine whether states reform healthcare on their own.
In This Issue
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Foreword
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Overview of U.S. Managed Care
Federal Regulation of Health Maintenance Organizations
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ERISA and the Courts
Federal vs. State Regulation of Health Care Plans
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Lower Court Holding
Decision of the Seventh Circuit U.S. Court of Appeals
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Before the Court
The Justices Weigh in During Oral Arguments
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Pro & Con
Does ERISA Allow States to Regulate the Review of Health Maintenance Organizations' Medical Decisions?
