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This opinion column was submitted by Reno attorney Matthew Sharp.
Health insurance companies collect premiums in return for an insurance contract that includes promises of insurance coverage. Yet one of the ways insurance companies increase their bottom-line profits is by automatically denying treatments for devastating diseases like cancer, without regard to the terms of the insurance contract and even in cases where physicians and medical researchers have concluded the treatment is safe and effective.
More shockingly, health insurance companies often choose to ignore the coverage promises they make to policyholders in their own written contracts by utilizing undisclosed “corporate medical policies” to deny claims without regard to the terms of those same insurance contracts. These corporate medical policies are used as “hidden exclusions” to attempt to justify insurance companies denying treatment, even though the policies are not actually part of the contract.
This is essentially what Sierra Health and Life, a division of UnitedHealthCare, recently did to Bill Eskew, a Las Vegas man who was diagnosed with stage 4 lung cancer in 2015 and sought a potentially lifesaving treatment called proton beam therapy (PBT). The PBT was both recommended by his doctors and covered by his insurance plan. Sierra Health and Life improperly used a corporate medical policy it never disclosed to Eskew to automatically deny his claim. The denial followed a cursory review by one of Sierra Health and Life’s contract physicians who spent no more than 12 minutes reviewing Eskew’s claim. Because of the denial, Eskew underwent another treatment, called intensity-modulated radiation therapy (IMRT). Ultimately IMRT caused significant injury to Eskew, the same injury the PBT was intended to prevent. Eskew suffered significant pain, suffering and mental anxiety, and he died an agonizing death in 2017.
In April, a jury in Las Vegas awarded Eskew’s estate a $200 million verdict for “insurance bad faith.” The jury made a statement that an insurance company should not use hidden corporate medical policies to unfairly deny a claim for cancer treatment. We represented the family of Eskew.
Through its corporate medical policies, Sierra Health and Life claimed that PBT was unproven and not medically necessary to treat lung cancer. Yet radiation oncologists — doctors who treat cancer patients with radiation — throughout the country and at some of the best cancer centers in the country use PBT because it is a proven and medically necessary treatment. In fact, proton therapy has been an effective weapon used to battle cancer for more than 60 years. (UnitedHealthcare entities even own an interest in and operate a PBT center of their own in New York City.) One of our experts, Dr. Andrew Chang, a San Diego-based radiation oncology specialist with expertise in pediatric oncology and proton beam radiation oncology, says: “Insurance companies prefer IMRT because it’s cheaper. Denying PBT is purely a financial decision.”
Insurance companies have been getting away with their outrageous practices for decades — without push back from Congress. With the help of attorneys like us, insured patients and their families have the courage to hold health insurance companies responsible and accountable for unfair insurance practices.
Our call to action to anyone who pays health insurance premiums is this: Let your state and federal representatives know you support legislation that holds insurance companies accountable to act in good faith. We should all demand that insurance companies cover physician-approved treatments, especially when the insurance company promises to do so in the insurance policies they sell to us.
Matthew Sharp is a Reno attorney who represented the family of Bill Eskew, the Las Vegas man who died after his insurance company denied a potentially lifesaving treatment for lung cancer.
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