Congressional Digest

Supreme Court Debates March 2002 No. 3 Vol. 5
Foreword

HMO Coverage Decisions

Contesting "Medical Necessity" of Out-of-Network Treatments

Foreword

When 25-year-old Debra C. Moran began experiencing pain, numbness, and decreased mobility in her right shoulder in 1995, she went to see her doctor. Like nearly 80 million other Americans, she belonged to a health maintenance organization (HMO), which provided her medical care through a network of enrolled physicians, clinics, and hospitals. Over the course of the next seven years, Moran’s case would become the focal point of a legal battle between States, the Federal Government, and corporate giants of the health care industry.Moran was initially diagnosed with carpal tunnel syndrome, and she had surgery in 1996. When her ailment…

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