Court Backs HMOs on Abuse

By Shannon Augustus | July 7, 2008 | 8:21 PM EDT

( - The U.S. Supreme Court has ruled against a woman who sued her hospital for prematurely discharging her a day after surgery.

Ruby Calad was told by a Houston-area hospital a day after her hysterectomy that she had to be released because her HMO, Cigna Healthcare of Texas, Inc., would not approve any additional expenses. Because she was released early, Calad ended up in an emergency room a few days later.

Justice Clarence Thomas, who wrote Monday's ruling, relied on a federal pension benefit law that said patients may pursue claims only in federal courts, where awards are limited to only the cost of medical services the HMO would not cover.

This ruling makes it difficult for patients like Calad to receive large amounts of damage awards if their HMOs refuse to pay for doctor-recommended health care.

"The court essentially looked the other way on the issue of the HMO abuse," said Calad.

Cigna stated that Calad's health care plan at the time, and like most health benefit plans "does not promise to cover any and all health care sought or desired by beneficiaries."

The Supreme Court said HMOs are protected from lawsuits in state courts, where juries are more prone to side with victims and recommend multimillion-dollar judgments from insurance companies.

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