The State of the Law on Insurance Coverage for State-of-the-Art Medical Treatments

Abstract

Over the past 5 years, there have been countless lawsuits throughout the country involving insurance coverage for state-of-the-art medical treatments, such as high-dose chemotherapy supported by bone marrow or peripheral stem cell rescue for breast cancer (“HDC/ABMR” OR “HDC/PSCR” respectively). Until recently, most policies have had some type of general exclusion for “experimental” or “investigational” treatment. A number of policies defined the terms, but many did not. With or without a definition, the ambiguities caused by the insurance industry's attempt to deny coverage for medically necessary treatments which were still being studied and refined caused the unfortunate influx of lawsuit after lawsuit.