Proton Beam Coverage Denial Challenged By Firm Client

Firm client Todd Taylor has brought an ERISA class action complaint against his health insurance administrators, Anthem Insurance Companies, Inc. and The Elevance Health Companies, Inc. over their coverage denial for proton beam therapy. Proton beam therapy is a procedure that deposits protons over a very small area, allowing a precise targeting of high doses of proton beams to a tumor, with no “exit  dose” beyond the tumor involved. It enables patients to tolerate higher total doses of radiotherapy, compared with photons, which are used for traditional intensity-modulated radiation therapy. It is viewed as particularly useful in treating tumors near vital organs or structures, where surgical excision or administration of adequate doses of conventional radiation is difficult or impossible. It is also associated with reduced risk of ischemic heart disease, including fatal heart attacks. Defendants denied Taylor’s coverage request, contending that the treatment wasn’t medically necessary, which Taylor alleges breaches his plan’s language.

Taylor is represented by Jordan Lewis, P.A., Alyson Beridon of Herzfeld, Suetholz, Gastel, Leniski & Wall, PLLC, John Yanchunis of Morgan & Morgan Complex Litigation Group, and Robert Sparks of Strauss Troy Co., LPA.

A copy of the Complaint is attached here.