Florida judge slams insurer for refusing to cover cancer patient's treatment citing 'high cost and efficacy'

UnitedHealthcare, the nation's largest insurance company, has found itself embroiled in a class-action lawsuit related to its denial of coverage for cancer patients undergoing proton beam therapy


                            Florida judge slams insurer for refusing to cover cancer patient's treatment citing 'high cost and efficacy'

A federal judge did not mince his words when he recused himself from hearing a class-action lawsuit against UnitedHealthcare regarding denials of treatment for cancer patients because of his own cancer battle, calling the insurers "immoral and barbaric."

According to CNN, the case that came to US District Judge for the Southern District of Florida Robert N. Scola was filed by the lawyers of Richard Cole, a prominent Miami attorney who was diagnosed with prostate cancer at the age of 70 in April 2018. 

The lawsuit stated that Cole was advised to undergo proton beam therapy, an expensive alternative to standard radiation that proponents say is a more precise form of treatment with fewer side effects, only to then see treatment delayed because UnitedHealthcare, the nation's largest insurance company, refused to cover it.

It also alleged that thousands of others had similarly been denied coverage of the treatment, which has been questioned because of its high cost and an apparent lack of studies proving its efficacy.

Scola did not look too kindly upon UnitedHealthcare, writing in a scathing opinion where he confirmed his recusal, "It is undisputed among legitimate medical experts that proton radiation therapy is not experimental and causes much less collateral damage than traditional radiation. To deny a patient this treatment, if it is available, is immoral and barbaric."

He cited his own battle with prostate cancer and how, after he had consulted with the "top medical experts around the country," they opined "that if I opted for radiation treatment, proton radiation was by far the wiser course of action."

Scola also brought up the case of a friend who had been diagnosed with cancer in 2015 and had to shell out $150,000 after UnitedHealthcare refused to pay for his proton beam radiation from MD Anderson Cancer Center. "Only upon threat of litigation did UnitedHealthcare agree to reimburse him," he wrote.

United Healthcare did not comment on Scola's remarks and instead pointed out that it had updated its policies this past January to allow more coverage of proton beam therapy for various cancers.

Referring to prostate cancer specifically, they said they had found proton beam radiation and traditional radiation "are proven and considered clinically equivalent." Addressing the changes, spokesman Matthew Wiggin said, "UnitedHealthcare works every day to ensure our members have access to proven, clinically effective care."

"We cover cancer therapies that have been clinically proven to be safe and effective, including, for some cancers, proton beam therapy," he continued. "Our medical policies and coverage decisions evolve based on the most current published clinical and scientific evidence and we continually review and update these policies and coverage decisions."