A landmark case involving one woman's battle against her health maintenance organization (HMO) began this week as attorneys explained to the U.S. Supreme Court why their client's insurer should cover her medical expenses. Debra Moran personally paid for a rare $94,000 operation to treat a nerve disorder in her arm after her HMO, Rush Prudential Inc., refused to pay the bill. Rush offered to pay for a more traditional procedure, but Moran and her doctors insisted that she needed the radical surgery.

Moran sued Rush Prudential in state court and won. However, the HMO still denied her full coverage. The Supreme Court must decide whether federal law preempts Moran's state court victory. If the Supreme Court finds in favor of Moran, states may be able to force HMOs to pay for various medical procedures based on state review board recommendations.