UnitedHealthcare has reached a settlement to resolve three proposed class action lawsuits alleging that the insurer wrongfully denied coverage for a specialized cancer treatment that plaintiffs claim is more effective but significantly more expensive than traditional radiation therapy.
The lawsuits, filed in 2019 by three members, were consolidated in the U.S. District Court for the District of Massachusetts. The plaintiffs alleged that UnitedHealthcare systematically denied coverage for proton beam radiation therapy, forcing them to pay tens of thousands of dollars out-of-pocket for the treatment.
The plaintiffs, who were covered under different employer-sponsored health plans administered by UnitedHealthcare, claimed that the insurer violated ERISA by improperly classifying the therapy as "experimental" or "investigational" and denied coverage based on that classification. They argued that PBRT is a well-established treatment for certain cancers, particularly in cases where traditional radiation therapy could cause significant damage to surrounding healthy tissue. The plaintiffs sought declaratory and injunctive relief, as well as reimbursement for the costs they incurred for the treatment.
UnitedHealthcare denied the allegations, saying that its coverage decisions were consistent with the terms of the respective health plans and that it acted in good faith. The insurer also argued that the plaintiffs failed to exhaust administrative remedies and that there had been no breach of fiduciary duty. The parties reached a settlement on Jan. 21, the details of which are expected to be submitted for court approval by April.