We feel for the UnitedHealthcare legal team. They must be worn out these days, what with so many lawsuits taking them to task for alleged misdeeds like fraud and illegally refusing to cover care. Now, they’ve got another case on their docket—a potential class-action suit from three cancer survivors denied coverage by United for their proton beam radiation therapy (PBRT).
The survivors accuse United of refusing to cover their PBRT because of its price tag. Each paid between $85,000 and $126,000 for their PBRT treatment—and they’d like their money back. A judge has denied United’s motion to dismiss the lawsuits, ruling that United’s refusal to cover this treatment was arbitrary and capricious.
United says it denied the claims because it deemed PBRT for their cancers as experimental treatment. It’s an odd way to define “experimental,” as the therapy was FDA-approved more than 30 years ago and is covered by both Medicare and Medicaid.
The ruling is good news for potentially countless patients up against denials of PBRT, and for the doctors who determine when the treatment is necessary. It’s also a victory for those of us who believe that cancer treatment should follow doctors’ orders—not insurers’.
