A federal judge has denied UnitedHealthcare’s motion to toss a class-action lawsuit over coverage for proton beam therapy.
Three patients each sued the insurer alleging that it arbitrarily denied coverage for the treatment for their cancers, and the cases were later consolidated. The cancer survivors said they each paid between $85,000 and $126,000 for the treatment, according to court documents.
The patients allege that the insurer denied coverage because proton beam therapy is more costly than other cancer treatments.
“Notwithstanding defendants’ arguments to the contrary, plaintiffs have alleged more than just that their requests for pre-authorization for [proton beam therapy] were arbitrarily and capriciously denied,” the judge wrote. “Rather, they have alleged that UnitedHealthcare has developed and applied [its policy] to broadly deny coverage for PBRT, even though it is safe and effective because it is more expensive.”
The plaintiffs say that UnitedHealth’s coverage policy for proton beam therapy denies current science and flies in the face of the fact that the treatment is covered by both Medicare and Medicaid.
UnitedHealthcare said in a statement to Fierce Healthcare that it will “continue to vigorously defend this matter.”
“We are committed to providing our members coverage for safe, proven and clinically effective health care services, which is why we rely on guidance from medical societies, published studies and evidence-based protocols to make these coverage decisions,” the insurer said. “We cover cancer therapies including, for some cancers, proton beam therapy.”
“We continually review and update our medical policies and coverage decisions based on the most current published clinical and scientific evidence,” UHC said.