Bills to expedite review of insurer denials of cancer treatment nixed

Feb. 06--Two bills inspired by problems patients at Hampton University's Proton Therapy Institute have had with insurance coverage died in a House panel when legislators declined to make or second any motion on them.

The bills, sponsored by Del. David Yancey, R-Newport News, were meant to fast-track appeals when insurers deny coverage of cancer treatment.

One of Yancey's bills would have allowed cancer patients to seek an independent outside review when their insurer denies a claim for treatment before they've exhausted all of the insurer's internal appeals.

Insurers are violating a Virginia law meant give patients a fair shot at proton therapy, a Hampton University representative says, and the angered parent of the state's only proton therapy center is thinking of legal action.

But the head of the state's trade association for health insurers says...

Insurers are violating a Virginia law meant give patients a fair shot at proton therapy, a Hampton University representative says, and the angered parent of the state's only proton therapy center is thinking of legal action.

But the head of the state's trade association for health insurers says...

The other would have set a 72-hour deadline for that independent review to decide. If not, the review body would be deemed to have reversed the insurer's denial.

Because no member of the House panel hearing the 72-hour bill moved to either approve it, kill it or continue it until next year, it died without any vote.

The same thing happened when no member seconded Yancey's motion to approve his other bill.

"As long as the clock is ticking, it is ticking, unfortunately, to the advantage of the insurance company," said Bill Thomas, HU's associate vice president for government relations.

"People don't know where to go and what to do," Thomas said.

He said opening up the external review process sooner would help patients get a disinterested decision sooner.

And setting the 72-hour deadline, with the kicker that failing to decide by that time would be deemed a reversal of a coverage denial, would ensure that time doesn't run out for seriously ill cancer sufferers.

Doug Gray, executive director of the Virginia Association of Health Plans, said there had only been one instance when an appeal through the state Bureau of Insurance's independent review process took longer than 72 hours.

"What problem are we trying to fix?" he said.

But Yancey said he's heard from people across the state whose insurers denied claims for proton therapy treatment.

He said that was a surprise after his bill last year saying insurers could not hold proton therapy to a higher standard than other cancer treatments.

Gray said the 72-hour bill would unfairly hold insurers responsible for others' inaction.

He said state law already allows patients to seek outside review of a denial of coverage while also pursuing insurers' internal review process.

Yancey's two bills this year were part of a package of bills urged by Hampton University, which has complained for years that insurers are unfairly denying coverage of proton therapy.

Yancey's other bills directed the state Bureau of Insurance to look into how insurers' cover proton therapy and required coverage for proton therapy treatments that are part of a clinical study.

Both died last month.

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The university's proton therapy institute began treating patients in 2010, and Thomas says getting insurers to pay has been a challenge that is denying many patients the benefits of the treatment. Proton therapy uses a focused beam of radiation at specific frequencies in stronger doses than in other types of radiation treatment.

Insurers say proton therapy is far costlier than other treatments and question its efficacy.

They say the medical studies conducted so far have been performed by proton therapy centers that have a vested interest in making a case for the treatment.

Ress can be reached by telephone at 757-247-4535

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