Insurers’ Internal Policies Latest Legal Front in Treatment Fight (1)

Kate Weissman paid $95,000 out of pocket after UnitedHealthcare refused to cover a cancer treatment called proton beam therapy. Now cancer free, she wants her insurer to pony up, and her best weapon is a recent federal court decision over guidance documents one insurer uses to make those decisions.

Attorneys who bring class actions against insurers are closely watching the developments, which may herald a new front in the battle over insurers erroneously classifying claims as experimental or not medically warranted and denying coverage on those grounds.

Insurers make those decisions using internal guidance documents that patient advocates argue can ...