Proton center, Oklahoma patient file suit against insurer over coverage

May 11--A cancer treatment facility using proton therapy is suing Blue Cross and Blue Shield of Oklahoma for denying coverage for a patient's prostate cancer treatment.

Oklahoma ProCure Management, which operates a proton therapy center in Oklahoma City, and Randy Farland, who is seeking treatment at the facility, have filed a lawsuit against the health insurance company, which denied Farland's proton therapy claims last year.

Opened in 2009, ProCure is one of two proton therapy facilities in the state and uses a form of radiation treatment that targets cancer in ways designed to minimize damage to healthy tissues.

"Before April of last year it was covered," said Les Yonemoto, a radiation oncologist at ProCure. "But they changed their coverage policy and all of sudden it's not covered and there is no medical reason for it."

The lawsuit, which was filed in Oklahoma County, claims Farland was denied authorization by Blue Cross and Blue Shield of Oklahoma four times in 2015. The lawsuit seeks the approval of coverage and more than $75,000 in damages.

Blue Cross and Blue Shield of Oklahoma declined to comment on the case and said it had not yet been served with the lawsuit.

"Privacy laws prohibit us from discussing any individual's insurance matters without their written consent," spokeswoman Ashley Hudgeons said.

Some medical studies continue to debate whether proton therapy is more effective at treating cancer, and the Journal of the National Cancer Institute reported last year the median Medicare reimbursement for proton therapy is double that of intensity-modulated radiation therapy (IMRT).

Rep. Marian Cooksey, R-Edmond, who authored legislation last year barring health insurance providers from holding proton therapy to higher standards than other types of radiation treatment, said there is a cost savings when you consider the decreased side effects compared to IMRT.

"It's a new technology that we need to embrace because in the long run it will save lives and it will save money," Cooksey said.

Before authoring last year's bill, Cooksey said she had heard several stories from Oklahomans who were denied coverage of proton therapy treatment.

Farland said he was diagnosed over a year ago and believed he would be cancer free if Blue Cross and Blue Shield agreed to cover the treatment.

"The drawn-out appeals process has really taken a toll on me and my family," Farland said in an email. "I am an emotional wreck, fighting cancer and now I have to fight my insurance company in court."

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