How are denials of care handled in the rest of the country? An article in the February AARP Bulletin presents an inconclusive picture of the effectiveness of protections for consumers in managed care plans. Forty-one states have passed laws allowing consumers to ask for an external review of an insurer’s decision by independent medical experts. Eleven states allow patients to sue their HMOs for damages if a denial of care causes harm, and 18 states have created state-funded ombudsman plans. State laws, however, apply only to individuals who are not in employer-sponsored health plans. Federal law, through the Employee Retirement Income Security Act (ERISA), governs employer-sponsored health plans.