Document Type
Article
Media Type
Text
Abstract
Over one hundred million Americans receive their health care benefits under some kind of managed care plan. At the heart of every managed care plan is an emphasis on cost containment. The courts traditionally protected the proprietary economic interests of managed care by holding that claims against managed care organizations and plan directors were preempted under the Employee Retirement Income Security Act (ERISA). This was done as a means of facilitating a better health care delivery system for Americans and in spite of the number of patients who suffered poor health consequences as a result of decisions by managed care insurers to deny requested benefits. However, by holding that "mixed eligibility decisions" by medical directors are not preempted by ERISA, and that claims against managed care plans for the denial of benefits should proceed under state malpractice law, the United States Supreme Court in Pegram v. Herdrich may have paved the way to reverse that trend. For Pegram's full effect, states will either have to reconsider premising malpractice on the traditional patient-physician relationship, or take a more novel approach like Wisconsin and require that medical directors be licensed physicians who must carry medical malpractice insurance.
First Page
63
Last Page
92
Publication Date
11-1-2003
Department
Other
ISSN
0734-1490
Language
eng
Publisher
Northern Illinois University Law Review
Recommended Citation
Boos, Karene M. and Boos, Eric J.
(2003)
"Killing the Fatted Calf: Managed Care Liability in a Post-Pegram World,"
Northern Illinois University Law Review: Vol. 24:
Iss.
1, Article 4.
Suggested Citation
Karene M. Boos and Eric J. Boos, Killing the Fatted Calf: Managed Care Liability in a Post-Pegram World, 24 N. Ill. U. L. Rev. 63 (2003).
