The U.S. Supreme Court will review lawsuits brought against two health insurers in Texas state courts to decide whether managed-care companies can be sued for negligence over their failure to pay for medical care recommended by a doctor. The justices agreed to hear appeals by Aetna, Hartford, Conn., and Cigna Corp., Philadelphia, in which the health plans argued they are protected from state malpractice lawsuits by the federal Employee Retirement Income Security Act of 1974. In one case, Aetna enrollee Juan Davila was prescribed the painkiller Vioxx for arthritis, but Aetna required him to try two other less-expensive medications first. After three weeks on cheaper pain relievers, Davila was rushed to the emergency room suffering from bleeding ulcers. He later sued, claiming Aetna acted negligently in not covering Vioxx from the outset. In the other case, Cigna would not authorize more than one day in the hospital for hysterectomy patient Ruby Calad despite her doctor's recommendation. Several days after her release, Calad suffered complications. She sued Cigna, claiming the insurer acted negligently in deciding more hospital time could not be authorized because it was not medically necessary. In both cases, the 5th U.S. Court of Appeals in New Orleans ruled last year that the lawsuits were not pre-empted by ERISA, which regulates employer-provided health benefits. -- by Laura B. Benko
High court to rule on right to sue health plans
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