This week’s notable decision allows three cancer patients to proceed with their case challenging United Healthcare’s policy of denying proton beam therapy. In Weissman v. United Healthcare Ins. Co., 19-cv-10580, 2021 WL 858436 (D. Mass. Mar. 8, 2021) (Judge Allison D. Burroughs), three cancer patients brought a putative class action alleging that United Healthcare and their individual healthcare plans violated ERISA by wrongfully denying medically necessary proton beam therapy cancer treatment (“PBRT”). Lead class plaintiff Kate Weissman was able to come up with over $125,000 to privately pay for medically necessary proton therapy treatment to treat her cervical cancer diagnosis after UHC denied her coverage for the treatment in 2016. She, along with two other named plaintiffs – Zachary Rizzuto and Richard Cole – brought suit challenging UnitedHealthcare’s application of its own internal guidelines on proton therapy as flawed and out-of-date.
Continue Reading A Proton Beam Therapy Class Action Survives a Motion to Dismiss
Three Wins for Participants
There is an embarrassment of riches this week for plan participants, as three cases share the notable decision spotlight. Two are significant plaintiff wins with respect to mental health coverage under ERISA healthcare plans. The third is an important arbitration decision from the Second Circuit involving a pension plan, also a big win for plan participants.
Continue Reading Three Wins for Participants
Blue Shield Must Face Lawsuit for Denied Proton Beam Radiation Therapy Claim Despite Paying Provider Directly
This week’s notable decision, Rois-Mendez v. California Physicians’ Service dba Blue Shield of California, Case No. 20-cv-02227, 2021 WL 242906 (C.D. Cal. Jan. 25, 2021), is a proton therapy cancer treatment denial case with a twist. Rois-Mendez was covered under a fully-insured Blue Shield plan when he was diagnosed with parotid gland cancer