Jun 1 2001
Cancer patients say HMOs refused proton beam
Updated: 2001-05-31 17:01:44 EDT (Reuters Health)
- A nonprofit outfit is suing five of California's largest HMOs for
allegedly denying coverage for proton beam radiation therapy to treat
Cancer Victims for Quality Healthcare, a California-based
organization, filed the class action lawsuit to force the insurers to
cover the therapy.
The complaint contends that Blue Shield of California, Cigna
Healthcare of California, Health Net Inc., PacifiCare of California and
Kaiser Permanente "systematically deny [proton beam therapy] on the
grounds that it is 'experimental' and/or 'investigational.'"
"This lawsuit does not seek money damages. Rather, we hope to bring
an end to the unequal treatment of insureds across the state concerning
proton beam radiation therapy for the treatment of prostate cancer,"
said plaintiffs' counsel Michael J. Bidart, of Shernoff Bidart
Darras, a Claremont, California-based law firm.
Research shows that proton beam therapy is suitable for treating
prostate cancer and less risky than standard radiation therapy, the
complaint contends. In the late 1990s, Medicare's intermediary in
California approved proton beam radiation as an accepted treatment for
prostate cancer, it says.
Rebutting the allegations, Health Net spokesman David Olson said
that the Los Angeles-based insurer covers proton beam radiation therapy
for prostate cancer when it is appropriate. "We've been covering it for
about 3 years," he said.
When asked whether the dispute might arise from the health plan's
definition of appropriateness, Olsen rejected that explanation,
chalking it up instead to "an opportunistic plaintiffs' attorney."
Kaiser spokeswoman Laura Marshall said that decisions about whether
to cover a specific therapy are left up to its doctors. Within the
Kaiser Permanente network, "if your doctor thinks that a certain
treatment or a certain drug that's not on the formulary is needed, you
get it," she said.
Blue Shield of California, however, considers the therapy
experimental for the treatment of prostate cancer and not eligible for
coverage, spokeswoman Laura Perry told Reuters Health.