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How courts view experimental treatments.
1Anderson Kill Olick & Oshinsky, P.C., NY.
Journal of Health Care Benefits
|April 8, 1994
Summary
Patient lawsuits over insurance coverage for autologous bone marrow transplants highlight challenges in defining "experimental" cancer treatments. These cases reveal conflicts between patient access and health plan exclusions for novel therapies.
Area of Science:
- Oncology
- Health Law
- Health Insurance Policy
Background:
- Autologous bone marrow transplant is a complex cancer treatment.
- Health insurance plans often face coverage disputes for treatments deemed "experimental".
Purpose of the Study:
- To examine the implications of patient lawsuits concerning insurance coverage for autologous bone marrow transplant in breast cancer treatment.
- To identify the core issues arising when health plans attempt to exclude "experimental" therapies.
Main Methods:
- Analysis of legal cases involving insurance coverage denials for autologous bone marrow transplant for breast cancer.
- Review of health plan policies and definitions of "experimental" treatments.
Main Results:
- Lawsuits illustrate significant challenges in the classification of autologous bone marrow transplant as "experimental".
- Disputes highlight the tension between medical innovation and insurance coverage limitations.
Conclusions:
- The definition and exclusion of "experimental" treatments by health plans create barriers to patient access for potentially life-saving therapies.
- Legal challenges underscore the need for clearer guidelines and policies regarding novel cancer treatments and insurance coverage.