State of Illinois
Respondent
John Philip Schmidt, Counsel of RecordIn 1987, the State of Illinois amended a 1974 act regulating health maintenance organizations (HMOs) to allow program enrollees who had been denied a specific medical treatment recommended by their primary physician to appeal to an independent physician. If the independent doctor concurred with the primary physician, the HMO would have to cover the procedure. In January 1998, Debra C. Moran sought an independent review of a decision by her HMO, Rush Prudential HMO, Inc., not to cover a relatively new form of microsurgery by a nonaffiliated doctor to treat an ailment in her shoulder….
