OKLAHOMA CITY – An Oklahoma City cancer treatment facility is taking on a well-known health insurance company, claiming the company interfered with patient care.
ProCure Proton Therapy Center and a patient, Randy Farland, have filed a lawsuit against Blue Cross Blue Shield after the company denied paying for Farland’s treatment for prostate cancer.
“Randy is an ideal candidate for proton therapy because we can aggressively treat the prostate cancer while reducing damage to the surrounding normal tissue such as the bladder and rectum,” said Dr. Les Yonemoto.
Health officials say Farland visited several oncology specialists and proton therapy was recommended by doctors to treat Farland’s cancer.
When he filed with his insurance company, Blue Cross Blue Shield denied his coverage four times, including the denial of two appeals and an external review, ProCure officials say.
Doctors say it has been one year since his diagnosis and he is still awaiting treatment.
“Blue Cross Blue Shield covered proton therapy for prostate cancer until April of last year, and now, inexplicably, it will not,” Yonemoto said. “Physicians, not insurance companies, should be directing treatment plans for cancer patients. Insurance coverage should not be arbitrarily denied by insurance companies when the result is the denial of medically necessary treatment for their cancer.”
Legislation passed last year prohibits health insurers from holding proton therapy to a higher standard of clinical effectiveness than other radiation treatments.
A spokeswoman, Ashley Hudgeons, told the Associated Press on Monday that Blue Cross has not been served with the lawsuit and had no comment.