Office of the Attorney General News Release Archive

Friday, Aug. 23, 2002

STATE CONTINUES EFFORTS TO PROTECT PATIENTS' RIGHT TO INDEPENDENT REVIEW OF HMO DECISIONS

Patient protection at stake as case returns to the 5th Circuit Court of Appeals

AUSTIN - Texas Attorney General John Cornyn has asked the 5th Circuit Court of Appeals to reconsider a previous ruling that struck down the right of patients to get a second opinion when their HMO denies coverage for "medically necessary" treatment. Today's action follows a recent U.S. Supreme Court decision upholding a similar review process in Illinois.

At issue is a law State legislators passed in 1997 that set up an appeals process for Texans who are denied coverage by their managed healthcare plan. In June 2000, the 5th Circuit Court accepted arguments made by insurance companies that federal laws preempt the State's independent review process. Earlier this year, however, the nation's highest court rejected similar arguments in the Illinois case and ordered the 5th Circuit to review the Texas HMO reform law.

"Patients and their doctors deserve the final say in what constitutes a medically necessary procedure," Cornyn said. "Texans shouldn't have to wonder whether their insurance company will abandon them in their hour of need."

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*Note: The Texas case is styled Corporate Health Insurance, Inc. v. Montemayor, Cornyn


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