Dynamic Accident Lawyers: Man Sues for Bad Faith Denial of Proton Therapy Cancer Treatment

The cofounder of a popular home-improvement website visited his doctor for symptoms of a sinus infection and was instead given devastating news.

Ronnie C. was diagnosed with a rare form of brain cancer, giving him a 50 percent chance of living 10 years.

He underwent intensive brain surgery and radiation to treat the cancer. But now, Ronnie is dealing with another stress — the fallout from his insurance company denying him coverage for his radiation therapy.

The radiation therapy, known as proton therapy or proton beam therapy, uses protons, rather than x-rays, to target diseased tissue. Proton therapy cost Ronnie hundreds of thousands of dollars, and insurance coverage was denied because the insurance company deemed the treatment was “experimental/investigational.”

Ronnie and his lawyers think they have a case against the decision, and Ronnie hopes his fight against the insurance company will help other brain cancer patients who need proton therapy get coverage as well.

Health Insurance Coverage Denial

Unfortunately, denial of health coverage in California is an all too common complaint from many individuals who have faith that their health insurance will help with their treatment costs no matter what their health situation turns out to be.

Individuals often undergo treatment as recommended by their doctor only to find out, like Ronnie did, that insurance companies may decide not to pick up the tab.

In a case involving proton therapy, some California insurance companies have historically had some leeway in deciding what types of procedures to cover. Some California insurance companies will only cover less expensive x-ray radiation even though some disease experts have said proton therapy may be more effective in treating certain types of cancers.

Bad Faith Insurance in California

Some California insurance companies have a reputation for providing bad faith insurance — a widespread practice where companies willingly do not pay, delay or deny payment on claims that are considered legitimate.

Sometimes, a claim denial for coverage is as simple as a coding or billing error that can easily be resolved with a phone call. However, many times, there is more to claim denial than a bookkeeping error.

What to Do When Your Claim Has Been Denied Coverage

There are a few steps to take if your health insurance company has denied an insurance claim. First, you should find out why your claim was denied. It may be something easy to resolve.

Second, you can file an appeal against the denial. You may need to provide a more detailed explanation of why you think the treatment should be covered and add supporting evidence from your physician.

Third, if you are denied coverage following your appeal, you can request an external review. An outside reviewer will look at the case and decide if they side with the insurance company or if they side with you.

Lastly, if the external review still resulted in a denied insurance claim, you may be able to file a California bad faith insurance lawsuit. An experienced bad faith insurance attorney can review your case and can assist you in determining your legal options.

Join a Free California Bad Faith Insurance Lawsuit Investigation

A bad faith lawsuit investigation has been launched into allegations that some California insurance companies are refusing to pay valid medical claims or offering to pay far less than the claim is worth. Some of the companies being investigated for potential violations include:

Aetna
Anthem Blue Cross
Blue Cross of California
Blue Shield of California
Cigna
Health Net
Kaiser Permanente
Secured Horizons
United Healthcare
WellPoint
Others

If you or a loved one were denied coverage for autism treatment, mental health treatment, plastic surgery skin removal after weight loss, proton therapy for cancer, or some other medically necessary treatment, you may have a legal claim.

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