Legal Opinion
Debra C. Moran, and State of Illinois, Intervenor-Appellant v. Rush Prudential Hmo, Incorporated
Court of Appeals for the Seventh Circuit
Decided October 19, 2000No. 99-2574PublishedCited by 46 opinions
1Opinion of the Court
RIPPLE, Circuit Judge.
Section 4-10 of Illinois’ Health Maintenance Organization Act (“the HMO Act”), 215 III. Comp. Stat. Ann. 125/1-1 et seq., requires HMOs to submit to an independent physician review when there is a disagreement over whether a course of treatment is medically necessary between a patient’s primary care physician and the HMO. In the event that the independent reviewer determines that the treatment is necessary, the HMO is required under § 4-10 of the HMO Act to cover the treatment.
Debra Moran’s primary care physician recommended a specific surgery for her, but Rush'…
2Cases cited19 opinions
- Celotex Corp. v. Catrett, Administratrix of the Estate of CatrettSupreme Court of the United States · 1986
- Shaw v. Delta Air Lines, Inc.Supreme Court of the United States · 1983
- Pilot Life Insurance v. DedeauxSupreme Court of the United States · 1987
- Metropolitan Life Insurance v. TaylorSupreme Court of the United States · 1987
- Metropolitan Life Insurance v. MassachusettsSupreme Court of the United States · 1985
14 more not listed; retrieve them via the Exa API.
3Cited by46 opinions
- Margaret Stewart Jamey L. Paulson William Keith Laura Spencer Lee Callison Stephanie Glowa Terri Gorecki Dan Berryman v. U.S. BancorpCourt of Appeals for the Ninth Circuit · 2002
- Rush Prudential HMO, Inc. v. MoranSupreme Court of the United States · 2002
- Trustees of the Aftra Health Fund v. BiondiCourt of Appeals for the Seventh Circuit · 2002
- United States v. Kamal PatelCourt of Appeals for the Seventh Circuit · 2015
- Kolbe & Kolbe Health & Welfare Benefit Plan v. Medical College of Wisconsin, Inc.Court of Appeals for the Seventh Circuit · 2011
41 more not listed; retrieve them via the Exa API.