Cancer patients say HMOs refused proton beam treatment

Last 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 prostate cancer.

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.