if the terms of the health care plan specifically exclude from coverage the cost of an appendectomy, then any injuries caused by the refusal to cover the appendectomy are properly attributed to the terms of the plan itself, not the managed care entity that applied those terms. 4 Respondents also argue that ERISA § 502(a) completely pre-empts a state cause of action only if the cause of action would be pre-empted under ERISA § 514(a); respondents then argue that their causes of action do not fall under the terms of § 514(a). But a state cause of action that provides an alternative remedy to those provided by the ERISA civil enforcement mechanism conflicts with Congress’ clear intent to make the ERISA mechanism exclusive. See Ingersoll-Rand Co. v. McClendon, 498 U. S.133, 142 (1990) (<HOLDING>). 5 ERISA § 514(b)(2)(A), 29 U. S. C. §
holding that the plaintiffs causes of action were preempted because their claims were premised on the existence of an erisa plan recognizing cause of action holding that ejven if there were no express preemption under erisa  514a of the cause of action in that case it would be preempted because it conflicted directly with an erisa cause of action recognizing cause of action for equitable estoppel under erisa recognizing the cause of action