WASHINGTON, D.C. -- April 11, 2003 -- The United States Supreme Court has ruled that states can pass laws requiring HMOs to open their networks to qualified doctors who want to join (Kentucky Association of Health Plans, Inc. v. Miller, No. 00-1471; April 3, 2003). The Court upheld Kentucky's "any willing provider" statute, which prohibits "a health insurer from discriminating against any provider who is ...willing to meet the terms and conditions of participation established by the ...insurer." The case also involved a second Kentucky any willing provider law, which applied to chiropractors.
In rejecting the argument that the Kentucky laws were pre-empted by federal legislation (the Employee Retirement Security Act of 1974 or ERISA), the court handed a victory to consumer groups who believe that states should have greater power to regulate health care and that patients need broader health care choices. The Kentucky willing provider laws were originally passed as part of a state health-care reform act. Rural lawmakers were concerned that local health-care providers could be excluded from health insurance networks.
Almost half the states have passed any willing provider laws in response to complaints that HMOs stop people from seeing doctors of their choice. These states are Alabama, Connecticut, Delaware, Georgia, Idaho, Illinois, Indiana, Massachusetts, Minnesota, Mississippi, New Hampshire, New Jersey, North Carolina, North Dakota, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming. Some industry groups claim that other states will not press to pass similar laws because HMOs are already expanding their networks for business reasons. However, these industry groups are still concerned with the erosion of ERISA's hold on HMO disputes and view many state laws as unfriendly to HMO interests.
Brayton Purcell is concerned that consumers receive appropriate health care. If you or a family member has been unfairly treated by your heath insurer or in the handling of other types of insurance claims, we are available to discuss your rights. Please feel free to contact us.