Marshfield vindicated

Article Abstract:

A federal judge's decision to throw out the remainder of Blue Cross Blue Shield United of Wisconsin's antitrust case against physician-owned Marshfield Clinic represents a victory for physician-owned networks. The decision to throw out the rest of Wisconsin Blue's case is another in a string of court decisions unfavorable to the health insurer; the original verdict, handed down in January 1995, awarded $48.5 million to Wisconsin Blues.

Outpatient Care Facilities, Outpatient Care Centers, Direct Health and Medical Insurance Carriers, Hospital and medical service plans, Medical Care Insurance, Editorial, Ambulatory care facilities, Health insurance, Health insurance industry, Clinics, Marshfield Clinic, Blue Cross Blue Shield United of Wisconsin

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HMO must cover high-dose chemotherapy treatment

Article Abstract:

A Georgia health maintenance organization refused to authorize recommended high-dose chemotherapy and bone marrow transplantation for a 51-year-old woman with metastatic breast cancer. The patient sued in state court, and the case was transferred to federal court, which decided in her favor. An injunction forced the HMO to authorize timely treatment with high-dose chemotherapy before the patient's condition became worse.

Breast cancer, Chemotherapy

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Texas clinic challenges drug budgets: new law basis of physicians' suit against HMO

Article Abstract:

The Fort Worth Clinic has mounted a legal challenge to its contract with health maintenance organization Methodist Health Plan, saying that the deal violates Texas' Medical Practice Act. The clinic's doctors oppose contract stipulations that, for example, restrict spending on prescriptions to 9.6% of premium dollars. The Medical Practice Act makes it illegal to deny medically needed care based on financial incentives.

Administration of Public Health Programs, Offices & clinics of medical doctors, Physicians & Surgeons, Offices of Physicians (except Mental Health Specialists), Health Programs-State, Physicians, Medical professions, Health policy, Methodist Health Plan, Fort Worth Clinic

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