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Preemption and Exhaustion Requirements Thwart Medicare Advantage Plan Members’ Ability to Hold Health Insurers Accountable

Most states have statutes or common law that allow an insurance policyholder to bring a civil action and seek more than just compensatory damages (e.g., punitive damages) when her insurance company denies coverage in bad...more

Blue Cross Found to Be Behind the Times: Fifth Circuit Finds Blue Cross’ Proton Beam Treatment Guidelines Are Outdated, Superseded...

Background - Revisiting the topic from an article published earlier this year, another plaintiff has successfully challenged a commercial insurer’s internal Proton Beam Radiation Treatment (“PBT”) policy. PBT is a proven...more

The Cost of Not Covering Proton Radiation Therapy

In 2018, an Oklahoma jury awarded $25.5 million to the family of a cancer patient denied coverage for proton radiation therapy by Aetna. The case involved the denial of coverage for Orrana Cunningham, who had stage 4...more

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