Litigation
Jun. 1, 2001
Patients Sue for Therapy They Say Is Needed
LOS ANGELES - In a class action filed Wednesday, a group of cancer survivors and their family members accused five of the state's largest HMOs of fraudulently denying them insurance coverage for a radiation therapy for prostate cancer.
The plaintiffs, represented by Shernoff, Bidart & Darras of Claremont, sued Blue Shield, Cigna, Health Net, PacifiCare and Kaiser for refusing to cover proton-beam radiation therapy.
The therapy, according to the complaint, is a medical necessity, not an alternative treatment as insurers claim.
"We are seeking an injunction so the entire health care industry will stop denying treatment [that they say] is experimental," plaintiffs' attorney Michael Bidart said.
Bidart noted that numerous cases are pending in Orange, San Bernardino and Los Angeles counties, where individuals have sued HMOs for denying this treatment.
If successful, this lawsuit, for which Bidart seeks class-action status, would change the entire health care industry, he said.
Michelle Naiditch, spokeswoman for Blue Shield, said Wednesday the organization has not been served with the lawsuit. However, Blue Shield considers proton-beam therapy an experimental treatment and, therefore, ineligible for coverage.
She said also that Blue Shield reviews each claim on a case-by-case basis.
Bidart said the plaintiffs have applied for class-action status because the number of affected plan members are too many to name. The lawsuit seeks an injunction to prevent the HMOs from denying the treatment to plan members, accusing the health organization of unfair business practices. Cancer Victims for Quality Healthcare v. California Physicians' Service, BC251394 (L.A. Super. Ct., filed May 30, 2001).
The plaintiff, Cancer Victims for Quality Healthcare, is a nonprofit organization formed from a support group of cancer survivors and their family members at Loma Linda University Medical Center.
According to the suit, the health maintenance organizations refused to cover proton-beam therapy, in which doctors steer "with exacting precision" the proton radiation beams to the tumor, stopping short of entering other organs.
The treatment protects healthy organs from radiation damage. Proton-beam treatment is suitable particularly for treating cancer tumors of the prostate, which are near sensitive areas such as the bowel, bladder and testes.
The control of the radiation beam allows an oncologist to significantly increase the dose to the tumor target and minimize complications to surrounding tissue, the lawsuit states. Physicians have used the treatment for 10 years, Bidart said.
The defendants forced plan members to appeal the HMOs' claim denials, on the grounds that the treatment was experimental, the suit states.
Donna Huffaker
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