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ERISA - Retrospective Utilization Review pt has already...

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Retrospective Utilization Review : pt has already received tx, so worst that can happen is  someone loses money   Prospective Utilization Review : now fight over  access to care   STATE LAWS : Insurance companies have to promptly pay claims in good faith.  -->Allow for recovery of damages in excess  of claims   In US: pensions  come from private employers   Employment Retirement Income (aka Pension) Security Act : also regulated employee benefit  plans (fringe benefits --> including health insurance) Problem: for big employers in several states, diff laws in every state --> ERISA super cedes state laws for employers with employees in multiple states   Private Cause of Action : provided to employee if employer violates ERISA --> sue in fed court --> Court does well with cases where it decides who should receive  money   Prospective Utilization Review
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