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Biotech / Medical : PFE (Pfizer) How high will it go? -- Ignore unavailable to you. Want to Upgrade?

To: DT who wrote (3706)	6/24/1998 12:58:00 PM
From: Zebra 365	Read Replies (4) \| Respond to of 9523

<<The HMO executives making the decision to exclude Viagra are aware that by continuing to cover other ED products they are in an extremely vulnerable legal position.>> Time for a little lesson on health care payment systems. Most people who work for a multi-state company do not have health insurance in the indemnity sense of insuring them for their expenses related to health care. They have health care BENEFITS which are created under the Federal ERISA act of 1974. That makes health care coverage a benefit that cannot be regulated by the states (or their courts). It makes it into something like vacation time. If you don't like your amount of vacation time you cannot go to the state Department of Vacations and complain. You cannot sue for more vacation time and you cannot sue in State court for better "health benefits". The lawyers will just move for dismissal on the grounds of premption by the Federal law, and the Federal courts have generally declined to interpret this law as it applies to health benefits. So the employer really determines the benefits that you may receive and the HMO or TPA is just an agent of the employer in providing these benefits. That is why the language of the HMO's press releases is worded that way, "if the employer wishes to cover it". Those of you who have health care benefits from your employer can verify this by checking your "insurance card". I bet that most will never find the word "insurance" printed anywhere on that card. If you have indemnity insurance, that is another story and is regulated by your state insurance commissioner. But by 1997, only 15% of employees still had indemnity insurance as opposed to " health benefits" administered by a TPA such as an HMO or PPO. I'm not a lawyer, I just fight this battle daily in my practice, and I deal with it in a large physician organization. Zebra