The medical community and the public meet new advances in medical technology and treatment with excitement. However, insurance companies rarely embrace cutting edge therapies like the rest of the population does. Insurance companies often label new treatments as “experimental” even when they have a proven record of success.
Under most health insurance policies, medical treatment deemed experimental is not covered. This means that if patients wish to pursue experimental treatment, they do so footing the bill themselves. So how exactly does an insurance company decide if a treatment is experimental? You might think the process involves a sophisticated analysis of scientific and medical research, but the reality is that the process is often much simpler.
All insurance companies are first and foremost a business. When new treatments become available, insurance companies look at costs as part of their valuation in determining whether or not they are considered experimental. This was the case with insurance giant Aetna when an Oklahoma woman was denied lifesaving treatment because the company deemed the treatment experimental. Aetna was eventually ordered to pay $25 million for its bad faith denial.
Cancer Treatment Is Not Experimental
Advances in cancer treatment have greatly improved the survival chances of patients. These treatments, such as proton beam therapy, are far from experimental and have actually been used for decades. In many instances, treatments that have been deemed experimental by insurance companies are actually approved not only by the U.S. Food and Drug Administration, but also exist as covered treatment under Medicare.
Insurance companies have no right to deny lifesaving treatment just because they don’t want to pay out on these claims. Policyholders who regularly pay their premiums deserve full coverage under their policies. When insurance companies operate in bad faith, they need to be held accountable.
Texas Insurance Attorneys
The experienced Texas insurance attorneys at Raizner Law have helped scores of policyholders in fights against some of the largest insurance companies in the country. We help policyholders protect their rights and get the most out of their policies. Contact us today to schedule an appointment with one of our attorneys for a free consultation.