U.S. Supreme Court failed us all, Write your congressperson

The US Supreme Court unbelievably ruled to deny damages to a patient covered by an ancient statute (ERISA) which pre-empts State Law for self funded third party administered plans. Here is the link. http://story.news.yahoo.com/news?tmpl=story&cid=533&e=3&u=/ap/20040621/ap_on_go_su_co/scotus_hmos Get your congress person's address here: www.obesitylawyers.com GET ACTIVE Gary Viscio

Gary, What does this basically mean? Can you break down in words that ALL of us can understand. Does this mean that ALL Insurance companies that state they don't cover WLS can't be forced to pay for WLS even if the patient is in need of having it in order to save their life? Donna

No. It means that in coverages where your employer self funds the plan and makes the rules you cannot sue the HMO for anything more then the cost of the surgery or medical treatment. One of the cases involved was in regard to the type of drugs a company would pay for, the other was with CIGNA where in Texas they refused to pay for another night's stay for a patient. So being unable to pay she left, became sick and suffered complications. She tried to sue for her pain and suffering but the Court held that if she won she is only entitled to the cost of the medical treatment she would have received. What is that? A day in the hospital? Meanwhile she suffered for weeks because despite her doctor asking them to let her stay some insurance company made a medical decision. That was the jist of it. It also points out how there needs to be sweeping changes in the Law. The Court said that themselves. Some person working for a carrier cannot be allowed to make decisions that are contrary to what your doctor has recommended. They say it's the Lawyers looking for money. Ok, true, there would be lawsuits, but if Congress stepped in and made these companies cover costs that YOUR doctor deemed necessary, NOT their company, then there would be no issues.

I agree that everyone needs to write their senators. ERISA only benefits employers, not the employees it was supposed to protect.