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Patient sues UnitedHealthcare for treatment denial

On Behalf of | May 10, 2019 | Medical Malpractice

Cancer is definitely a life-threatening diagnosis, and when doctors fail to diagnose it in time, patients can die. But sometimes patients are put at risk not because of any negligence from their health care providers but due to denials of care from their health insurance carriers.

Such was the case for one 30-year-old married woman from Charlestown. Her doctor initially prescribed chemotherapy and radiation to shrink the tumors found in her cervix. However, her cancer was very aggressive and soon spread elsewhere in her body.

Her doctors still believed she had a decent chance at survival with beam proton radiation, a newer and much more expensive treatment regime that specifically targeted the cancerous tumors without degrading her other internal organs.

Her insurer, UnitedHealthcare, denied coverage for the $95,000 treatment at Massachusetts General Hospital, which was essentially handing down a death sentence for her. They claimed that proton beam therapy was an experimental treatment option that was no more effective than traditional radiation treatments.

An appeal, and subsequent denial followed, which the increasingly desperate patient discovered was commonplace. She filed a lawsuit against UnitedHealthcare for the wrongful denial of her treatment in March in Boston’s federal court. Because she is one of many patients who was denied proton beam radiation, she also seeks class-action status for her claim.

The patient was able to receive treatment after her parents cashed in their life savings and wired $90K to MassGen for her treatment. The hospital eventually refunded her parents $40K. Three years hence, the patient is cancer-free.

The insurance industry is reluctant to sign on for treatments that they consider experimental and that have a lower chance of success. But for desperate patients, the treatment can be their only shot at life.

If your health insurance carrier denied you the treatment that you need to save your life, you may decide to hold them legally accountable for this lapse.