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Supreme Court to Rule on Patients’ Rights

November 3, 2003

WASHINGTON (AP) _ The Supreme Court said Monday it will settle a fight over patients’ rights in court when their HMOs refuse to pay for recommended medical treatment, an issue at the heart of the long debate over efficiency versus service in managed health care.

The case involves an issue that has stymied Congress, which has tried and failed to pass national patients’ rights legislation. Some states have passed their own patient protection laws, but the question of where patients can sue and what they can ask for in court is still unresolved.

For patients, the court’s answer could determine whether they can win large amounts of money in court if health insurers refuse to pay for beneficial or even lifesaving treatment.

If the court sides with insurers, it would mean that state courts, and the potential they offer for large damage awards from juries, would be off limits for most negligence or malpractice suits against HMOs.

Lower courts have divided over the question of whether federal law allows the kind of negligence or malpractice suit at issue in this case.

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