INSURER COVERAGE: NJ Judge Orders HMO to Pay for Infant’s Care
A New Jersey judge has taken the unprecedented step of ordering an HMO to provide care. Superior Court Judge R. Benjamin Cohen ordered University Health Plans "to pay for 24-hour nursing care it denied a 5-month-old baby who survives on breathing and feeding tubes," the AP/Asbury Park Press reports. Caitlin King was born Oct. 12 to Mary King, a medical student at the University of Medicine and Dentistry of New Jersey. King received her health insurance through University Health Plans, a school subsidiary. The plan originally paid for three weeks of 16-hour care for the infant, who needs around-the-clock nursing care, subsequently reducing it to 12 hours per day. "The HMO argued that the parents should stay at home to provide the care themselves," said Lee Goldsmith, the family's attorney. The HMO was ordered "to provide around-the-clock nursing care until a full hearing on April 16." Paul Armstrong, a health care attorney and medical ethics expert, said that while courts often order hospitals and nursing homes to provide care, it is unusual for such an order to be issued to an HMO. He said, "Once a managed care plan starts making medical decisions, they face the same consequences that flow from that as other decision makers do, including having the courts and the Legislature tell you what to do" (4/1).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.