Cancer Patient Suing Blue Cross Wins Proton Beam Therapy Appeal

Blue Cross & Blue Shield of Louisiana wrongly denied coverage for a cancer patient’s proton beam therapy by relying on outdated medical necessity guidelines from an outside source, the Fifth Circuit ruled.

Blue Cross declined to approve proton beam therapy for Robert Salim’s throat cancer by relying on a third-party guideline providing that the treatment isn’t medically necessary for patients with head and neck cancer. But this guideline was based on policies from the American Society for Radiation Oncology (ASTRO), which have since been updated to approve proton beam therapy for Salim’s exact condition, the US Court of Appeals for ...