Anthem’s Coverage Denial for Proton Beam Therapy OK’d by Judge

Anthem Blue Cross Blue Shield properly declined to cover a prostate cancer patient’s proton beam therapy treatment, a California judge ruled, saying the case was governed by a recent Ninth Circuit decision involving the same treatment and the same doctor.

Anthem’s decision that proton beam therapy wasn’t medically necessary to treat Loren Swearingen’s prostate cancer was based on the opinions of four physician reviewers and internal guidelines noting a lack of evidence demonstrating the therapy’s health impacts, Judge Mark C. Scarsi of the U.S. District Court for the Central District of California said Tuesday.

Scarsi cited the U.S. Court of ...