UnitedHealth Group has not responded to inquiries for comments. The settlement agreement mentions that “the defendant has denied all claims and competition.”
The court has yet to approve the settlement. If it proceeds, a final approval hearing will be arranged within at least 130 days.
Proton therapy is an increasingly popular method for treating both malignant and benign tumors. A doctor highlights its potential benefits due to the precision of proton radiation, which helps protect nearby organs from exposure. However, it’s important to note that it isn’t the ideal solution for every patient and doesn’t eliminate all risks associated with radiation.
The Mayo Clinic in Rochester is one of the well-known non-profit centers that has contributed to the technology’s development and is supported by various investor-owned facilities. Notably, Mayo is not involved in the lawsuit.
UnitedHealthcare’s healthcare policy for 2023 regarding proton beam radiation therapy (PBRT) recognizes this treatment as medically necessary for a limited number of cases, such as certain eye and skull-based tumors. The settlement indicates that PBRT is seen as clinically comparable to standard radiation for prostate cancer treatment, though “the need for healthcare will depend on the specific terms of the member’s benefits plan.”
Furthermore, the policy will eliminate specific mentions of 13 diagnoses. According to court documents, PBRT is considered “unproven or medically unnecessary” for bladder and breast cancer treatments. In certain cases, if comprehensive support for the treatment is lacking, “requests for exceptions will be evaluated individually.”
