AETNA HEALTHCARE INC

This paper reviews the Aetna Healthcare Inc. V. Juan Davila case. The case was one in which an employee of a company that contracted with Aetna Healthcare Inc., an HMO (health maintenance organization), a managed care company, to provide health care for its employees. The case also involved conflicts between federal and state laws (Aetna Healthcare Inc., FKA Aetna U. S. Healthcare Inc. et al. V. Juan Davila, 2004).

This review of Aetna Healthcare Inc. V. Juan Davila consists of a brief summary of the case two major discussions. The first major discussion reviews the major action and findings of the case. The second discussion assesses the advantages and disadvantages of the decision of the United States Supreme Court on the case when such advantages and disadvantages are considered from the perspective of private health care consumers, as opposed to the perspectives of health care funding entities and health care services provider organizations.

Summary of Aetna Health Inc. V. Juan Davila

Juan Davila participated in an employer-sponsored group health plan (an HMO) that was administered by Aetna Health Inc. Davila's employer contracted with Aetna Health Inc. to administer the health plan. In this capacity, Aetna Health Inc. established the formularies relevant to specific health conditions covered by the employer health plan. Davila's physician prescribed Vioxx for arthritis pain. Aetna Healthcare In

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la could have paid for Vioxx if he wanted to use it (Aetna Healthcare Inc., FKA Aetna U. S. Healthcare Inc. et al. V. Juan Davila, 2004). The argument that the Aetna decision amounted to directing specific medical care was completely rejected. The reasoning is strange to say the least, as Aetna develops and enforces formularies. The Supreme Court rejected other parts of the rationale of the ruling of Court of Appeals for the Fifth Circuit. The Supreme Court found that Davila asserted "tort claims for tort damages" which are not preempted by ERISA, instead of "contract claims for contract damages", which are preempted by ERISA (Aetna Healthcare Inc., FKA Aetna U. S. Healthcare Inc. et al. V. Juan Davila, 2004). The Supreme Court also rejected Davila's argument that the THCLA is not preempted by ERISA preemption because it regulates insurance. In this part of the ruling, the Supreme Court stated that the THCLA provides a "separate vehicle to assert a claim for benefits outside of, or in addition to, ERISA's civil enforcement rules" (Aetna Healthcare Inc., FKA Aetna U. S. Healthcare Inc. et al. V. Juan Davila, 2004). Advantages and Disadvantages of the Supreme Court Decision in Aetna Health Inc. V. Juan Davila when such Adva
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Approximate Word count = 1856
Approximate Pages = 7 (250 words per page)

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