In an article published in DOTmed on March 20, 2023, AGG Healthcare Litigation partner Rich Collins provided comments on Aetna Life Insurance Co.’s $3.4 million settlement to 142 cancer patients collectively in the suit, Molloy v. Aetna, which involves denied coverage for proton therapy.
Rich told DOTmed that these cases are the “catalyst for change” that are making insurers reconsider their stance on proton therapy.
“I have seen over the past five years, since we started litigating these cases, that a number of insurers have revised their guidelines to allow for greater utilization of proton therapy for more types of cancer diagnoses,” Rich said. “I view each revision as the insurers’ incremental concession of their losing basis for denying coverage.”
Rich also stated that, over the next five years, he expects commercial insurers will be focusing less on their proton therapy utilization guidelines, and focusing more on their reimbursement policies, developing alternative payment models that allow for greater access to proton therapy.
To read the full article, please click here.