Office of the Attorney General News Release Archive

Monday, June 24, 2002

SUPREME COURT ORDER FAVORS TEXANS' RIGHT TO INDEPENDENT REVIEW OF HMO MEDICAL CARE DENIALS

AUSTIN - The nation's highest court this morning granted Texas Attorney General John Cornyn's petition for a writ of certiorari, vacated a lower court judgment and remanded for reconsideration a legal decision that struck down a patient's right to seek a second opinion if a managed health care provider denies coverage for a "medically necessary" treatment.

The U. S. Supreme Court's order in the case, "Montemayor v. Corporate Health," directs the U.S. Court of Appeals for the Fifth Circuit to reconsider its June 2000 rejection of the State of Texas' argument that its "independent review" process on medical necessity determination is legal.

"Today's ruling is a victory for Texas health care consumers. Patients and their physicians deserve the final say in medically necessary decisions, not their insurance companies. A second opinion or independent review is not only wise in these important health care situations, it is legal under State and federal laws," Attorney General Cornyn said.

Last week, the U. S. Supreme Court upheld a similar Illinois independent review process in "Rush Prudential HMO, Inc., v. Debra C. Moran and State of Illinois.

The Fifth Circuit must now reevaluate Texas' law, which the Texas Legislature included in its HMO reform legislation passed in 1997, in light of the Moran decision. Previously, the Fifth Circuit agreed with insurance companies' arguments that two federal laws preempted Texas' independent review process. But similar arguments were rejected by the U. S. Supreme Court.

- 30 -


Go to Top