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Has Your Insurer Wrongfully Denied Proton Therapy?

Proton therapy is one of the most advanced methods for delivering radiation to cancerous tumors.  In the most basic terms, radiation damages the DNA of the cancerous cells, which often impedes the cell’s ability to divide and grow.  The advantage of proton therapy over traditional radiation treatment is that proton therapy is designed to deliver its radiation to the cancerous tumor and not move further, meaning fewer amounts of healthy cells are damaged in the process.  

In a recent report, approximately two-thirds (63%) of cancer patients ages 18 to 64 where initially denied coverage for proton therapy by their insurers, even though the treatment was recommended by the patient’s physician as the best course of treatment.  While the report reveals that patients, working with their doctors, are sometimes able to reverse the denial by the insurer, the initial denials place unnecessary delay on patients in need of critical treatment. The study also found that proton therapy is denied approximately 42% of the time, requiring on average five weeks before the insured receives the final denial from the insurer.  

Not all health insurance plans are alike.  While some health insurance plans are classified as “ERISA” plans, other plans fall under the umbrella of “Non-ERISA” plans.  This distinction is important because Florida provides remedies in state court for insureds who are wrongfully denied health insurance benefits for Non-ERISA plans.  The reason being is that Non-ERISA plans are not preempted by federal law. Even for those insureds who have ERISA plans, federal law provides remedies for wrongful denial of claims.  

If you, or someone close to you, believe you have been wrongfully denied coverage for a medical procedure, you should consult with counsel to determine whether you should explore bringing a claim for damages and/or a determination that the denied procedure should be covered under your insurance policy.  

Jason Cornell is a Florida attorney who represents consumers throughout the United States who have been wrongfully denied health insurance coverage.  You can reach Jason at 561 616-3333, or jcornell@liggiolaw.com.

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