Gale Encyclopedia of American Law Volume 6 P47 fully illuminates today's leading cases, major statutes, legal terms and concepts, notable persons involved with the law, important documents and more. Legal issues are fully discussed in easy-to-understand language, including such high-profile topics as the Americans with Disabilities Act, capital punishment, domestic violence, gay and lesbian rights, physician-assisted suicide and thousands more. | 448 MANAGER costs and discourage frivolous visits most HMOs now require members to make a copayment for most types of medical visits. HMOs also point to state laws that undercut their management of costs by giving members the right to go outside the HMO network of health providers for services. In addition members can now take advantage of state laws that provide appeal rights when denied medical services. HMOs and health insurance companies have challenged these state laws arguing that the 1974 federal EMPLOYEE RETIREMENT INCOME SECURITY ACT ERISA preempted these state laws. ERISA seeks to protect employee benefit programs which include pension plans and health care plans through a lengthy set of standards rules and regulations. Health care providers have pointed to the comprehensive nature of ERISA as demonstrating the intent of Congress to maintain a uniform national system. However the . SUPREME COURT has been unsympathetic to these arguments. In Moran v. Rush PrudentialHMO Inc. 536 . 355 122 S. Ct. 2151 153 L. Ed. 2d 375 2002 the . Supreme Court in a 5-4 decision upheld an Illinois law that required HMOs to provide independent review of disputes between the primary care physician and the HMO. Debra Moran had complained of continued numbness pain and loss of function and mobility in her right shoulder. A nerve conduction test revealed that she had braxial plexopathy which involves compression of the nerves. Moran researched this condition and found a doctor in Virginia who performed microsurgery to correct this type of problem. Because the doctor was out-of-network Rush Prudential refused to pay for Moran s consultation with him. The doctor diagnosed Moran as suffering from a syndrome that could be corrected with surgery. Moran gave her Illinois primary physician the diagnosis which was confirmed by two Rush-affiliated thoracic surgeons. Moran was not satisfied with the surgical methods offered by these two doctors. Even though Rush denied her coverage
