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UnitedHealthcare Wrongly Categorized Cancer Treatment as Experimental to Avoid Coverage

Recently, a class action against UnitedHealthcare was filed in the United States District Court for the Southern District of Florida. The class members in the lawsuit allege that UnitedHealth wrongly categorized proton beam radiation therapy as an experimental or investigational treatment for prostate cancer to avoid providing coverage. This suit took a drastic turn when the presiding Judge Robert N. Scola Jr. recused himself because of his personal view on UnitedHealth’s “barbaric policy.” Judge Scola, who survived prostate cancer himself, stated that “it is undisputed among legitimate medical experts that proton radiation therapy is not experimental and causes much less collateral damage than traditional radiation.” He further said, “to deny a patient [proton beam radiation therapy], if it is available, is immoral and barbaric.”

In November 2018, an Oklahoma jury awarded $25.5 million to the family of a cancer patient, Orrana Cunningham, denied coverage by Aetna. The jurors said that Aetna acted recklessly in denying the coverage of much needed proton beam therapy. Aetna denied her coverage, calling the therapy investigational and experimental. Proton beam therapy is not only approved by the U.S. Food and Drug Administration (FDA), but it is also a covered treatment under Medicare. The Cunninghams believe Aetna denied the claim for financial reasons, saving the insurer from paying out on expensive claims. They also pointed out Aetna’s in-house medical directors receive profit-based bonuses, exposing them to bias. Ms. Cunningham later died.  

Bad faith insurance denials or schemes to restrict coverage in the healthcare industry are common and patients pay the price. Policyholders that pay their premiums deserve full coverage under their policies. If you have received a bad faith insurance denial or has coverage issues, contact Frier Levitt today.