A federal judge dismissed a proposed class action challenging UnitedHealthcare's refusal to cover a certain type of cancer treatment known as proton beam therapy.
U.S. District Judge Allison Burroughs ruled that the plaintiff, Kate Weissman, would have to sue under a different provision of the Employee Retirement Income Security Act, or ERISA. While Weissman accused UnitedHealthcare of breaching its fiduciary duty, Burroughs said she should have sued the insurer for denial of benefits.
The judge also said the lawsuit doesn't contain any facts to support the argument that UnitedHealthcare's medical directors are unqualified to review prior authorization requests or to support claims against Weissman's employer.
Weissman's attorney Rich Collins, a partner at the law firm Callahan & Blaine, said the order is "a mere speed bump, not a roadblock," and said he will file an amended complaint to explain why a denial-of-benefit claim is inadequate.
Collins said the judge agreed with an important issue in the case: that UnitedHealthcare can be held responsible for the way it applied its clinical policy on proton beam therapy to health benefit plans.
"We are well on our way to exposing UnitedHealthcare's charade of calling proton beam radiation therapy experimental, investigational or unproven," he said in an email.
UnitedHealthcare did not immediately respond to a request for comment.
Proton beam therapy is a radiation therapy used by oncologists to kill cancerous tumors. Compared with traditional radiation, proton therapy is used to target a specific site on the body, limiting damage to surrounding tissues. Insurers have long been reluctant to cover proton beam therapy, which is more expensive than traditional radiation therapy.
Weissman, whose employer contracted with UnitedHealthcare for benefits administration, alleged that the insurer repeatedly denied coverage for proton therapy to treat her cervical cancer in 2016 based on a policy that relied on "outdated medical evidence." UnitedHealthcare argued that the therapy had not been proven to be more effective than standard radiation.
Weissman's case isn't the only lawsuit challenging UnitedHealthcare's denials for proton beam therapy. At least two other lawsuits are still pending.
