Rush Prudential HMO, Inc. v. Moran, 536 U.S. 355, 41 (2002)

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Cite as: 536 U. S. 355 (2002)

Thomas, J., dissenting

regarding medical standards, ante, at 383-384, it is in fact a binding determination of whether benefits are due: "In the event that the reviewing physician determines the covered service to be medically necessary, the [HMO] shall provide the covered service." 215 Ill. Comp. Stat., ch. 125, § 4-10 (2000) (emphasis added). Section 4-10 is thus most precisely characterized as an arbitration-like mechanism to settle benefits disputes. See Brief for United States as Amicus Curiae 23 (conceding as much).

There is no question that arbitration constitutes an alternative remedy to litigation. See, e. g., Air Line Pilots v. Miller, 523 U. S. 866, 876, 880 (1998) (referring to "arbitral remedy" and "arbitration remedy"); DelCostello v. Team-sters, 462 U. S. 151, 163 (1983) (referring to "arbitration remedies"); Great American Fed. Sav. & Loan Assn. v. Novotny, 442 U. S. 366, 377-378 (1979) (noting that arbitration and litigation are "alternative remedies"); 3 D. Dobbs, Law of Remedies § 12.23 (2d ed. 1993) (explaining that arbitration "is itself a remedy"). Consequently, although a contractual agreement to arbitrate—which does not constitute a "State law" relating to "any employee benefit plan"—is outside § 514(a) of ERISA's pre-emptive scope, States may not circumvent ERISA pre-emption by mandating an alternative arbitral-like remedy as a plan term enforceable through an ERISA action.

To be sure, the majority is correct that § 4-10 does not mirror all procedural and evidentiary aspects of "common arbitration." Ante, at 381-383. But as a binding decision on the merits of the controversy the § 4-10 review resembles nothing so closely as arbitration. See generally 1 I. Mac-Neil, R. Spediel, & T. Stipanowich, Federal Arbitration Law § 2.1.1 (1995). That the decision of the § 4-10 medical reviewer is ultimately enforceable through a suit under § 502(a) of ERISA further supports the proposition that it tracks the arbitral remedy. Like the decision of any arbitrator, it is enforceable through a subsequent judicial action, but judicial

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