Mansell, Engel & Cole

Insurers challenged for denial of cancer treatments

Proton radiation therapy for select cancer diagnoses has yielded strongly positive outcomes for cancer patients.

On the other hand, it has incurred comparatively higher costs for insurance companies in some instances, as well.

Those corresponding realities have created a resulting tension that has engendered a sad and predictable result in what critics say are too many cases.

Namely, that is this: coverage denial by insurers. They say that proton therapy is largely experimental and, as such, is outside the limits of what must be covered under a policy.

There are many opponents of that view -- individuals, families, medical experts, academics and legislators among them -- who charge that insurers' reluctance to cover proton treatments narrowly owes to one objection only: they just don't want to pay.

Lawmakers in Virginia reacted recently to that, passing legislation earlier this year that one media report notes makes it "illegal for insurance companies to hold proton therapy to a higher standard than other forms of cancer treatment … in their coverage determination."

The new statutory dictate was spotlighted late last month in a press conference underscoring that, notwithstanding its recent passage, many insurers continue to deny coverage simply because they don't want to pay for it.

One cancer patient's spouse speaking at the event noted that denial is happening "over and over again" and that families who are weakened and compromised through illness often cannot stand up adequately against insurers' wrongful conduct.

Hopefully a greater focus on the new law and heightened publicity aimed at recalcitrant insurers in that state will begin to make a difference.

Policyholders in every state -- with Oklahoma certainly being included -- should never feel overwhelmed when facing challenges from an insurer that they believe is acting unethically and/or illegally in delaying or denying a legitimate insurance claim.

Rather, they should take purposeful and proactive action by timely consulting with an experienced policyholders' insurance attorney, who can intercede on their behalf by demanding that a nonperforming insurer fully comply with the contractual duties it has pledged to honor.

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