Cancer Patients Group Sues Five MCOs for Denial of ‘Proton Beam’ Therapy Coverage
A not-for-profit organization yesterday filed suit in Los Angeles County Superior Court alleging that five managed care companies have "unlawfully den[ied] coverage" for a prostate cancer treatment, Bloomberg News/Los Angeles Times reports. In the complaint, Cancer Victims for Quality Healthcare charged that PacifiCare Health Systems Inc., Health Net Inc., Blue Shield of California, Kaiser Health Plan Inc. and Cigna Corp. illegally refused to cover "proton beam radiation therapy," which "shoots radiation at the tumor." The insurers, however, argue that patients' policies do not cover the procedure, which they consider an "experimental therapy." The patients group hopes to gain class-action status for the suit and has sought a court order that would force the companies to cover the treatment, which costs between $35,000 to $50,000. In the lawsuit, the group asks for restitution of legal fees and treatment costs for "class-action members" who have already paid for the therapy, but no punitive damages. Plaintiffs' attorney Michael Bidart said that Blue Cross of California and Aetna Inc. cover the proton therapy (Bloomberg News/Los Angeles Times, 5/31).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.