Stuart D. Morse & Associates, L.L.C. Stuart D. Morse & Associates, L.L.C.
Colorado Insurance Defense And Business Litigation Attorneys
Call Us Toll Free 866-825-5850

Proven or experimental? Opinions on health treatments can differ.

It is certainly a commonplace to spot stories in the media where insurers' bad-faith conduct is alleged. The focus of wrongful behavior is often on claims of unresponsiveness to policyholders' lawful demands or issued checks that don't fully cover costs.

And it is often the case that a news article will spotlight outright claim denial in alleged instances where equity called for acknowledgment and issued payment.

It is indisputable that insurers rather than claimants -- often sick, injured or otherwise disabled individuals -- most often bear the brunt of bad public relations when it comes to stories of clashes between policyholders and coverage providers.

Is that always fair?

Of course it isn't, despite the natural propensity of most people to quickly side with the perceived underdog in a contractual dispute.

One recent media report reveals the tarnished image that insurers in one state have recently received owing to their denial of coverage for cancer treatments using so-called Proton therapy in some instances.

Many insurers advance a seeming good-faith argument that Proton-based treatment can be far more experimental -- and, thus, unproven -- than is obviously the case with more established radiation and chemotherapy responses.

The common response from denied claimants that insurers are really balking at coverage simply because they are greedy and don't want to pay for it has received widespread reporting.

One national insurer recently reversed its course on Proton therapy coverage after initially denying a claimant. A spokesperson for Anthem Blue Cross and Blue Shield pointed out that the company ultimately approved Proton treatment after it became sufficiently clear following its customary review process that it would be safe and effective for that individual,

The company's response was a rebuttal to the charge that all Proton denials were grounded in corporate greed, with the spokesperson stating that the Blue Cross reversal owed to the insurer's concern that all members "have access to … evidence-based medical treatment that improves health outcomes."

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