Proton Therapy Insurance Lawsuit
A proton therapy insurance lawsuit may be an option for people who have had their coverage denied by their insurance company. Proton therapy is an FDA approved, reliable form of cancer treatment. Despite the potential effectiveness of proton therapy, some insurance companies are denying coverage to cancer patients due to the high cost of the treatment. In addition, doctors and patients are often stuck waiting to begin critical treatment because the appeals process can take weeks to complete.
When a policyholder submits a claim to his or her insurance company, they expect the company to act in good faith and honor the legitimacy of the claim. Most insurance companies consider proton therapy an acceptable form of treatment for certain types of cancer. In some cases, however, insurance companies are denying claims that should be honored. Affected patients and their families may be able to file a claim with the help of an insurance claim lawyer.
If you or a loved one is in a dispute with an insurance provider, or if your claim for proton therapy has been denied, contact Attorney Group to learn about your options. We offer free, no obligation consultations. We can help answer your questions, and if you choose to pursue a claim we can connect you with an affiliated attorney who can assist you throughout the legal process.
Have You Seen a Proton Therapy Insurance Lawsuit Commercial?
You may have seen a proton therapy insurance lawsuit commercial on television and wondered whether you or a loved one have been denied your insurance coverage and, if so, whether you are eligible to pursue a claim against the insurance company. The purpose of this article is to provide you with additional information about lawsuits and other litigation involving proton therapy so that you have a better understanding of your options.
What is Proton Therapy?
Proton therapy is a type of radiation therapy used treat cancers and noncancerous tumors. It uses high-energy beams from positively charged particles known as protons to treat tumors.
Proton therapy was approved by the U.S. Food and Drug Administration (FDA) in 1988 as a safe and reliable cancer treatment. There are over two dozen facilities offering proton therapy in the United States.
According to the Mayo Clinic, “studies have suggested that proton therapy may cause fewer side effects than traditional radiation,” but it is “not clear whether proton therapy is more effective in prolonging lives.” Although proton therapy can give doctors more control over the treatment’s energy concentrations, healthy tissue may still be affected. Side effects associated with proton therapy are similar those related to traditional forms of cancer treatments, including fatigue, digestive problems, headaches, hair loss, skin redness and soreness.
What Types of Cancers Are Treated With Proton Therapy?
Not all cancers are treated with proton therapy. Proton therapy may be used to treat certain cancers and conditions, including:
- Brain cancer
- Breast cancer
- Esophageal cancer
- Head and neck cancer
- Liver cancer
- Lung cancer
- Lymphomas
- Ocular and other eye conditions
- Pancreatic cancer
- Prostate cancer
- Sarcomas
- Tumors affecting the base of the skull
Because x-ray radiotherapy can potentially damage normal, healthy tissue, proton therapy may be used to limit the dose of radiation to critical organs and structures near a tumor, including the brain stem, spinal cord, healthy brain tissue, heart, lungs, trachea, major blood vessels, kidneys, esophagus, bone marrow, stomach, salivary glands, small and large intestines, and bladder.
Lauren A. on May 16, 2016
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Proton Therapy and Prostate Cancer
When used to treat prostate cancer, damage to the surrounding tissue may be reduced when treated with proton therapy.
According to the National Association for Proton Therapy, some studies have shown “increased survival rates for proton therapy patients when compared to patients treated with standard radiation therapy.”
Although proton therapy could potentially result in fewer side effects than traditional radiation therapy, many insurance companies have reportedly denied coverage for proton therapy because of the high cost of the treatment.
Likewise, insurance companies often claim that proton therapy is either experimental or even unnecessary. In some of these instances, insurers have been scrutinized for placing profits above the health of those they insure.
Proton Therapy Insurance Coverage
Very few hospitals in the United States offer proton therapy, and insurance coverage for proton therapy is often limited due to the high cost of the treatment versus the cost of x-ray radiotherapy. As technology becomes more affordable and new treatment centers open throughout the United States, the cost of proton therapy may decrease. However, proton therapy remains expensive, and some insurance companies have reportedly begun denying coverage for proton therapy, although proton therapy could potentially lead to fewer side effects,
According to a report by Alliance for Proton Therapy Access, “nearly two-thirds (63 percent) of cancer patients aged 18 to 64 whose physicians recommended proton therapy as the best course of treatment for their disease are initially denied by their insurer.” In some cases, patients and their physicians are able to successfully have the treatment approved through an appeals process, but the average wait time is nearly three weeks. In addition, cancer patients who were denied coverage waited approximately six weeks on average, according to the Alliance’s report.
In conjunction with cancer patients and their families, the Alliance for Proton Therapy Access is calling on state insurance commissioners to enforce current regulations and adopt a set of “common-sense” practices to hold insurance companies accountable and give cancer patients “fair, timely, and transparent access to cancer treatment.”
Why Would Your Insurance Coverage or Claim be Denied?
Insurance companies have a significant self-interest to avoid payouts to policyholders and to protect their cash reserves, and insurance policies are often drafted to define eligible claims very narrowly. When an insurance provider undervalues or denies a claim, it may argue that:
- the claim falls outside the scope of coverage;
- the insured failed to pay policy premiums on time, resulting in a lapse in coverage; or
- there was a material misrepresentation in the policy, excluding coverage for the claim in question.
Insurance companies are obligated to observe the terms of their contracts and refrain from engaging in unfair trade practices. Likewise, insurers are supposed to act in good faith and uphold the conditions of their contracts when a legitimate claim is made. There are some cases, however, in which an insurance company fails to fulfill its duties and engages in bad faith practices.
Is There a Proton Therapy Insurance Class Action Lawsuit?
At the time of this article’s publication, a proton therapy insurance class action lawsuit action has not been filed on behalf of patients who were denied coverage. Proton therapy insurance lawsuit attorneys are doubtful that a class action will be certified for patients who were denied coverage by their insurance provider.
Have There Been Any Proton Therapy Insurance Lawsuit Settlements or Verdicts?
According to multiple reports, a jury awarded $25.5 million to the family of Orrana Cunningham, an Oklahoma woman who suffered from stage 4 nasopharyngeal cancer near her brain stem. Cunningham’s insurance company, Aetna, denied her coverage in 2014 after doctors suggested that the patient receive proton therapy to pinpoint the tumor.
In 2015, Cunningham died in part due to a viral infection that reached her brain. Aetna is the third-largest insurer in the U.S., and according to a CNN report, claimed a “lack of clinical data supporting proton therapy for treating nasopharyngeal tumors.”
In some cases, personal injury lawsuits may settle early in the claims process when both parties come to a negotiated agreement. Other cases may go to trial where a judge or jury reaches a decision in a trial, known as a verdict, and awards financial compensation to the plaintiffs in the case.
Proton therapy insurance lawsuit attorneys note that the outcome of any case is never guaranteed, and past results are not necessarily predictive of future outcomes.
Proton Therapy Insurance Lawsuit News
- November 2018An Oklahoma jury awards $25.5 million to the family of a cancer patient whose coverage was denied by Aetna. The patient later died from a viral infection.
- 1990The Proton Therapy Treatment Center at the Loma Linda University Cancer Center in California becomes the first hospital-based proton treatment center in the United States.
- 1989The National Centre for Eye Proton Therapy is opened in the United Kingdom.
- 1946Robert R. Wilson first suggests the use of protons as an effective treatment method.
How a Proton Therapy Insurance Lawsuit Attorney Can Help
It may be difficult to determine whether a policyholder has a claim, so it is important to contact an insurance claim lawyer when disputes arise. In most instances, insurance claims are denied based on a good faith interpretation of the policy by a claims adjuster. However, certain rules of interpretation of insurance policies apply in many states that favor policyholders and may not be taken into account by the adjuster.
In some cases, insurance companies engage in bad faith or unfair claims handling practices, including:
- Engaging in deceptive practices or misleading the policyholder
- Fraud
- Conscious wrongdoing by the provider, including deliberate misinterpretation of policy language
- Refusal or neglect to fulfill a contractual obligation
When insurance companies engage in bad faith, policyholders may be entitled to compensation beyond payment of the claim. Insurance companies are most likely equipped with their own team of lawyers who will do whatever it takes to defend their client. For these reasons, it is advisable to contact an insurance claim lawyer to learn more about your rights and remedies.
