Kate Weissman is willing to brave litigation with a $150 billion health insurance company to bring about change in our healthcare system. On March 26, 2019, Ms. Weissman filed a class action lawsuit to challenge what she alleges to be UnitedHealthcare’s unfair and deceptive policies and procedures for determining whether a prescribed treatment or medication is medically necessary (utilization review). Ms. Weissman alleges that UnitedHealthcare’s utilization review process is skewed toward the denial of coverage based upon inadequate internal medical policies placed in the hands of unqualified medical directors. This alleged institutional pattern and practice of wrongful conduct results in the systematic denial of coverage for medically necessary proton beam radiation therapy (“PBT “) for UnitedHealthcare’s insured members suffering with cancer, while offering coverage for far less expensive, though far more harmful, conventional radiation treatment.
In October 2015, 30-year-old Ms. Weissman was diagnosed with stage IIB cervical cancer. After various treatments and a relentless battle for her life, her doctors from Massachusetts General Hospital recommended PBT to avoid grave damage to surrounding tissue and organs. On April 6, 2016, UnitedHealthcare denied coverage, contending that PBT is experimental or investigational or unproven. Ms. Weissman alleges that PBT is an established form of treatment that is widely accepted by physicians, government agencies and many insurers and other payers, including Medicare and Medicaid. UnitedHealthcare relied on its own internal policies, as interpreted and applied to Ms. Weissman’s case by UnitedHealthcare’s medical directors, in denying coverage for PBT. UnitedHealthcare would only agree to cover the more conventional intensity-modulated radiation therapy, which is about half the cost of PBT.
Ms. Weissman, who volunteers with Cervivor to advocate for the cervical cancer community, recognizes that she was fortunate enough to have the $95,000.00 to pay for the proton beam treatment ordered by her doctors so that she would not have to settle for the more dangerous and damaging conventional treatment. She is now fighting for those who cannot afford that choice.
The lawsuit was filed in the United States District Court, Central District of Massachusetts, Boston Division on behalf of Ms. Weissman by her attorneys, Rich Collins and Damon Eisenbrey of Callahan & Blaine in Santa Ana, California, in association with Lisa Kantor and Tim Rozelle of Kantor & Kantor in Northridge, California, and Mala Rafik of Rosenfeld & Rafik in Boston, Massachusetts. Mr. Collins stated that, “Kate was successful in a fight for her life and is now prepared to fight for change and hold UnitedHealthcare accountable so that others suffering from life-threatening illnesses will not have to agonize over wrongful coverage denials and crippling medical bills when they should be focusing on their survival and recovery.”
ABOUT LISA S. KANTOR: Mrs. Kantor is the Founding Partner of Kantor & Kantor, LLP, a law firm based in Northridge, California with offices also located in the Bay Area and San Diego. She is one of the nation’s leading experts in federal and state mental health parity laws, how to maximize insurance benefits, and how to obtain insurance coverage for mental health and eating disorder treatment. Mrs. Kantor has also contributed extensively to her field as lead counsel in the following seminal cases: Thompkins v. BC Life and Health Ins. Co., 414 F.Supp.2d 953 (C.D. Cal. 2006), Harlick v. Blue Shield of California, 686 F. 3d 699 (9th Cir. 2012), Rea v. Blue Shield of California, 226 Cal. App. 4th 1209 (2014). She has given talks to many organizations, including the 2016 White House Roundtable on Eating Disorders 2016, the 2016 The Kennedy Forum Parity Legal Taskforce 2016 and the 2018 ABA Joint Committee on Employee Benefits: Health & Welfare Benefit Plans Seminar. 818-886-2525; firstname.lastname@example.org.
ABOUT TIMOTHY J. ROZELLE: Mr. Rozelle is an Associate Attorney at Kantor & Kantor. He came to Kantor & Kantor after spending time at the California Medical Association (Sacramento) and California Department of Insurance. Mr. Rozelle’s practice is focused primarily on helping employees obtain wrongfully denied surgical, medical, mental/behavioral health and prescription drug insurance benefits under the Employee Retirement Income Security Act. He also represents individuals denied benefits under individual policies governed by state law. 818-886-2525; email@example.com.
ABOUT KANTOR & KANTOR: Founded in 2004, Kantor & Kantor is the largest law firm in the country (with 18 attorneys) exclusively representing plaintiffs who have been denied insurance benefits from life, health disability and long-term care policies. The firm has extensive experience with the complex appeals process and federal court litigation of ERISA matters. Our attorneys have over 160 years of combined experience and have helped individuals recover over $500 million in monetary relief from insurance companies. https://www.kantorlaw.net