TEXAS: Aetna Agrees To Salvage Independent Reviews
Texas and Aetna Inc. have reached an agreement to try to retain the state's independent review process after a federal judge invalidated it Friday. Judge Vanessa Gilmore ruled, in a lawsuit filed by Aetna, that the review board violates the 1974 Employee Retirement Income Security Act (ERISA). Aetna Chief Legal Officer David Simon, in a letter to state regulators Monday, said that the company's goal was to overturn the state's HMO liability law, which was part of the same measure, not the review process. The judge upheld the HMO liability law. "It is unfortunate that the ... process wound up being coupled with health plan liability rather than as an alternative to it," Simon stated. The Dallas Morning News reports that "both sides will ask [Gilmore] to leave the 10-month-old process intact, at least temporarily," while both parties "talk about [their] options" (Ornstein, 9/23). The Ft. Worth Star-Telegram reports that "[o]ne suggestion is to make the independent review process nonbinding." Geoff Wurzel, executive director of the Texas Association of Health Plans, said, "It was not our understanding, and I don't believe it was Aetna's plan, to get the (independent review) process thrown out." Indeed, in his letter, Simon stated that "the process encourages coverage while discouraging lawsuits." (Lunday, 9/23).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.